Ajite Hastaya Yaklaşım

Year 2019, Volume: 1 Issue: 3, 206 - 211, 20.12.2019

Demet Gülpek Ayşe Nur İnci Kenar Çiçek Hocaoğlu

https://doi.org/10.35365/ctjpp.19.1.27

Abstract

Ajitasyon, pek çok psikiyatrik ve tıbbi durumun seyri sırasında ortaya çıkabilen yaşamı tehdit edebilen bir durumdur. Ajitasyon, bir kişinin, kendisi ya da yakın çevresinin güvenliğini tehlikeye sokan her türlü sesli, sözlü ve/veya motor davranışlar kümesidir. Saldırgan davranışların gelişiminde biyolojik, sosyal, çevresel etkenler gibi birçok etmen rol oynar. Öncesinde psikiyatrik hastalık öyküsü olmayan aniden ortaya çıkan ajitasyon, saldırgan davranış ve dürtüsellik gösteren hastalarda, psikiyatri dışı tıbbi durumların mutlaka dışlanması gerekir. Klinisyenler açısından da tanı ve tedavi yöntemleri konusunda bazı güçlüklere yol açabilen ajitasyonun izlemi önemlidir. Bu nedenle klinisyenlerin ajitasyonu olan olgulara yaklaşımı, risk faktörlerini konusunda bilgi sahibi olmaları yaşam kurtarıcı olabilir. Bu derlemede ajite davranış açısından riskli bireylere yaklaşım ve tedavi süreçleri konusunda mevcut literatür bilgilerinin gözden geçirilmesi amaçlanmıştır. Çalışma için PubMed, Google Scholar, Türk Psikiyatri Dizini gibi arama motorları taranmış ve konu ile ilgili İngilizce, Türkçe dillerinde yazılmış tam metin olarak ulaşılabilen yayınlar çalışmaya dahil edilmiştir. Sağlık çalışanlarının ajitasyonu olan hastanın yönetimi konusunda eğitilmesi, bilgilendirilmesi gereklidir. Sağlık çalışanlarına ve hasta yakınlarına zor anlar yaşatan saldırgan davranış nedeni ile başvuran olgular için öncelikle güvenlik tedbirleri alınmalıdır. Saldırgan hastaların tedavisinde çevresel düzenleme, yatıştırma, bedensel tespit veya tecrit ve farmakolojik yaklaşım uygulanır.

Keywords

Ajitasyon, Saldırgan Davranış, ruhsal bozukluklar, risk faktörleri, tedavi

References

• Barr, J., Fraser, G.L., Puntillo, K., Ely, E.W., Gélinas, C., Dasta, J.F., Davidson, J.E. ve Devlin J.W. et al. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine, 41(1), 263-306.
• Blackburn, R. ve Coid, J.W. (1998). Psychopathy and the dimensions of personality disorder in violent offenders. Personality and Individual Differences, 25,129-145.
• Bilici, R., Sercan, M. ve Tufan, A.E. (2013). Psikiyatrik hastalarda saldırganlık ve saldırgan hastaya yaklaşım. Düşünen Adam The Journal of Psychiatry and Neurological Sciences, 26,190-198.
• Bjorkly, S.(1999). A ten year prospective study of agression in a special secure unit for dangerous patients. Scandinavian Journal of Psychology, 40(1),57-63.
• Chen, L., Xu, M., Li, G. Y., Cai, W. X., & Zhou, J. X. (2014). Incidence, risk factors and consequences of emergence agitation in adult patients after elective craniotomy for brain tumor: a prospective cohort study. PloS one, 9(12), 1-15.
• Choi, E. ve Song, M.(2003). Physical restraints in a Korean ICU. Journal of Clinical Nursing, 12(5), 651–659.
• Cornaggia, C.M., Beghi, M., Pavone, F. ve Barale, F. (2011). Aggression in psychiatry wards: A systematic review. Psychiatric Research, 189,10-20.
• Demir, A.(2007). Nurses’ use of physical restraints in four Turkish Hospitals. Journal of Nursing Scholarship, 39(1), 38-45.
• Dolan, M. ve Völlm, B.(2009). Antisocial personality disorder and psychopathy in women: a literature review on the reliability and validity of assessment instruments. The International Journal of Law and Psychiatry, 32(1), 2–9.
• Dunn, K., Elsom, S. ve Cross, W.(2007). Self-efficacy and locus of control affect management of aggression by mental health nurses. Issues in Mental Health Nursing, 28(2), 201-217.
• Dünya Sağlık Örgütü(World Health Organization).(2002). World report on violence and health. Geneva, Switzerland. World Helath Organization.
• Elbogen, E.B. ve Johnson, S.C.(2009). The intricate link between violence and mental disorder: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 66(2),152-161. Fazel, S., Gulati, G., Linsell, L., Geddes, J.R. ve Grann, M.(2009). Schizophrenia and violence: systematic review and meta-analysis. PLOS Medicine, 6(8), e 1000120.
• Flannery, R.B. Jr.(2007). Precipitants to psychiatric patient assaults: review of findings, 2004-2006, with implications for EMS and other health care providers. International Journal of Emergency Mental Health, 9, 5-11.
• Flannery, R.B. Jr, LeVitre, V., Rego, S. ve Walker. A.P. (2011). Characteristics of staff victims of psychiatric patient assaults: 20-year analysis of the Assaulted Staff Action Program. Psychiatric Quarterly, 82,11-21.
• Foster, C., Bowers, L. ve Nijman, H.(2007). Aggressive behavior on acute psychiatric wards: prevalence, severity and management. The Journalof Advanced Nursing, 58(2),140-149.
• Garriga, M., Pacchiarotti, I., Kasper, S., Zeller, S.L., Allen, M.H., Vázquez, G. ve Baldaçara, L. (2016). Assessment and management of agitation in psychiatry: Expert consensus. The World Journal of Biological Psychiatry, 17(2),86-128.
• Gunn, J. ve Bonn, J.(1973). Criminality and violence in epileptic prisoners. British Journal ofPsychiatry, 188:337-343.
• Harford, T.C., Yi, H. ve Freeman, R.C. (2012). A typology of violenceagaints self and others and its associations with drinking and other drug use amonghigh school students in a U.S. general population survey. Journal of Child & Adolescent Substance Abuse, 21,349-366.
• Harford, T.C., Chen, C.M., Kerridge, B.T. ve Grant, B.F.(2018). Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-II). Psychiatry Research, 262,384-392.
• Hodgins, S., Kratzer, L. ve McNeil, T.F.(2002). Obstetrical complications, parenting practices and risk of criminal behavior among persons who develop majör mental disorders. Acta Psychiatrica Scandinavica, 105(3), 214-226.
• Hopper, S.M., Babl, F.E., Stewart, C.E. ve Woo, J.V.(2012). Aggression management in a children’s hospital setting. Medical Journal of Australia,196(3),198–201.
• Hosker, C.M.ve Bennett, M.I.(2016). Delirium and agitation at the end of life. British Medical Journal,9;353:i3085.
• Jonker, E.J., Goosens, P.J., Steenhuis, I.H. ve Oud, N.E.(2008). Patient aggression in clinical psychiatry: perception of mental health nurses. Journal of Psychiatric and Mental HealthNursing,15(6), 492-499.
• Kay, S.R., Fiszbein. A.ve Opler, L.A.(1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.
• Krug, E.G., Dahlberg, L.L.ve Mercy, J.A.(2002). World report on violence and health. World Health Organization, s. 1‐18.
• Lee, K.A., Park. K.T., Yu, H.M., Jin, H.Y., Baek, H.S. ve Park, T.S.(2013). Subacute thyroiditis presenting as acute psychosis: a case report and literature review. Korean Journal of Internal Medicine, 28(2),242-246.
• Nordstrom, K. ve Allen, M.H. (2013). Alternative delivery systems for agents to treat acute agitation: progress to date. Drugs, 73,1783-1792.
• Miller. R.J., Zadolinnyj, K. ve Hafner, R.J. (1993). Profiles and predictors of assaultiveness for different psychiatric ward populations. American Journal of Psychiatry, 150(9),1368-1373.
• O’Donnell, O., House, A. ve Waterman, M. (2015). The co-occurence of agrression and self-harm: systematic literatüre review. The Journal of Affective Disorders, 175,325-350.
• Pacciardi, B., Mauri, M., Cargioli, C., Belli, S., Cotugno, B., Di Paolo, L., ve Pini, S. (2013). Issues in the management of acute agitation: how much current guidelines consider safety?. Frontiers in Psychiatry, 4, 26.
• Pacciardi, B., Calcedo, A.ve Messer, T. (2019). Inhaled loxapine for the management of acute agitation in bipolar disorder and schizophrenia: Expert review and commentary in an Era of Change. Drugs in R&D,19,15-25.
• Richard-Devantoy, S., Olie, J.P. ve Gourevitch, R.(2009). Risk of homicide and major mental disorders: a critical review. L'Encéphale, 35(6),521–530.
• Richmond, J. S., Berlin, J. S., Fishkind, A. B., Holloman, G. H., Jr, Zeller, S. L., Wilson, M. P. ve Ng, A. T. (2012). Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. The Western Journal of Emergency Medicine, 13(1), 17–25.
• San, L., Estrada, G, Oudovenko, N.Dobrovolskaya, N., Bukhanovskaya, O., Popov, M. ve Vieta, E.(2018). PLACID study: a randomized trial comparing the efcacy and safety of inhaled loxapine versus intramuscular aripiprazole in acutely agitated patients with schizophrenia or bipolar disorder. European Neuropsychopharmacology, 18,710-718.
• Steadman, H.J., Cocozza, J.J.ve Melick, M.E.(1974). Explaining the increate arrest rate among mental patients: the changing clientele of the state hospitals. American Journal of Psychiatry, 135:816-820
• Swanson, J.W., Holzer, C.D.E., Ganju, V.K. ve Jonio, R.T.(1989). Violence and psychiatric disorder in community: evidence from epidemiologic catchment area surveys. Hospital & Community Psychiatry, 40,605-608.
• Swift, R.H., Harrigan, E.P., Capperlleri, J.C., Kramer, D.ve Chandler, L.P.(2002). Validation of the behavioural activity rating scale (BARS): a novel measure of activity in agitated patients. Journal of Psychiatry Researh, 36,87–95.
• Şahingöz, M., Kendirli, K, Yılmaz, E., Sönmez, E.Ö., Satan, Y., Aksoy, F., Dağıstan, A. ve Kaya, N. (2014). Bir üniversite hastanesindeki psikiyatrik aciller. Selçuk Tıp Dergisi, 30,153-154.
• Tang, W.K., Liu. X.X., Liang, H., Chen, Y.K., Chu, W.C.W., Ahuja, A.T. ve Abrigo, J.(2017). Location of acute infarcts and agitation and aggression in stroke. The Journal of Neuropsychiatry and Clinical Neurosciences, 29(2),172-178.
• Teece, A., Baker, J.ve Smith, H.(2019).Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit. Journal of Clinical Nursing, 8.
• Turgay, A.S. ve Genç, R.E.(2009). Physical restraint use in Turkish Intensive Care Units. Clinical Nurse Specialist, 23(2), 68-72.
• Vieta, E., Garriga, M., Cardete, L., Bernardo, M., Lombraña, M., Blanch, J.ve Martínez-Arán, A. (2017). Protocol for the management of psychiatric patients with psychomotor agitation. BMC Psychiatry, 17(1), 328.
• Walsh, E., Gilvary, C., Samele, C., Harvey, K., Manley, C., Tattan, T., Tyner, P. ve Creed, F.(2004). Predicting violence in schizophrenia: a prospective study. Schizophrenia Research, 67(2-3),247-252.
• Wilson, M.P., Pepper, D., Currier, G.W., Holloman, G.H. ve Jr, Feifel. D.(2012). The psychopharmacology of agitation: consensus statement of the American Association for Emergency Psychiatry Project Beta Psychopharmacology Workgroup. Western Journal of Emergency Medicine, 13, 26–34.
• Wolf, M.U., Goldberg, Y. ve Freedman, M.(2018). Aggression and Agitation in Dementia. Continuum (Minneap Minn),24(3),783-803.
• Woods, P. ve Ashley, C.(2007).Violence and aggression: a literature review. Journal of Psychiatric &Mental Health Nursing, 14(7),652-660.
• Yılmaz, B. (2011). Şiddetin psikolojisi. Türkiye Klinikleri Journal of Psychiatry-Special Topics, 4(2),8-13.
• Yöyen, G.E.(2012). Yatan ve Poliklinikten Takip Edilen 1.Eksen Psikiyatrik Bozukluk Tanısı Almış Kişilerde Şiddet Türleri ve Eğilimlerinin Karşılaştırılması.(Doktora Tezi). İstanbul Üniversitesi, Adli Tıp Enstitüsü, İstanbul-Türkiye.
• Zeller, S.L.ve Citrome, L. (2016). Managing agitation associated with schizophrenia and bipolar disorder in the emergency setting. Western Journal of EmergencyMedicine, 17,165-172.