Psychomotor agitation: the path from neurosis to schizophrenia

The essence of the disease

Psychomotor agitation is a mental disorder that is accompanied by increased motor activity.
This condition is provoked by various pathologies. Depending on this, there are quite a few types of psychomotor agitation. This condition is accompanied by increased anxiety, irritability, feelings of anger or confusion. Sometimes patients show aggression or behave completely inappropriately.

The duration of excitation can vary - from an hour to a week. The severity of the manifestations of this condition is influenced by the underlying pathology.

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Reasons for deviations

Psychomotor agitation can be an acute reaction to a stressful situation that occurs in a mentally healthy person who finds himself in an extreme situation. It develops immediately after mental trauma or a life-threatening condition.

Often a person develops motor restlessness, after which he falls into a stupor.

In addition, the disorder may be a consequence of the following conditions:

1. Acute infectious pathologies . They are accompanied by intoxication damage to the nervous system as a result of exposure to viruses or bacteria.
2. Traumatic brain injuries . Also, psychomotor agitation can be a consequence of other brain lesions.
3. Acute and chronic intoxication of the body . Poisoning with quinine, caffeine, and atropine can lead to them. Also included in this category is delirium delirium.
4. Epilepsy.
5. Hysteria . This condition may be a reaction of the body to external factors.
6. Hypoxia and toxic brain damage . This condition can be observed in precomatous and comatose cases.
7. Psychical deviations . This category includes depressive psychosis, manic agitation, and schizophrenia. Bipolar affective disorder can also lead to psychomotor agitation.
8. Delirium . This term refers to clouding of consciousness, which is accompanied by figurative delusions, visual hallucinations, and a feeling of fear.

Epileptiform excitation

Psychogenic arousal is caused by severe psychological trauma. It can often have the character of a so-called vital threat, which tends to narrow consciousness, against the background of which fear and panic appear. Patients with oligophrenia experience eretic arousal, which is expressed in destructive actions without meaning and is accompanied by screams.

Manifested by sudden motor agitation with fear, aggression, various delusional ideas, loss of time and hallucinations, confusion of consciousness is called epileptiform excitation. Some time after leaving this state, amnesia often occurs. The person does not remember what happened to him and what actions he performed. This pathology is observed in cases of traumatic origin and epilepsy.

Reactive psychosis manifests itself in the form of a psychotic illness that appears as a result of a very strong shock, stress or psychological trauma. This condition can be changed if, after a correct diagnosis, adequate treatment is carried out in a timely manner.

Types of deviation

There are such types of psychomotor agitation, each of which is characterized by certain features:

1. Catatonic excitement - in most cases is accompanied by impulsivity and impaired coordination of movements. Sometimes rhythmicity and monotony of action occur, as well as increased talkativeness. This form of agitation is usually a manifestation of schizophrenia.
2. Hebephrenic agitation may be one of the stages of catatonic excitation. It manifests itself in the form of the patient's foolishness and meaningless movements. Sometimes this condition is accompanied by the patient’s aggression. This symptom also often indicates schizophrenia.
3. Hallucinatory arousal – accompanied by tension and increased concentration. In addition, a person may experience incoherent speech, variable facial expressions, aggressive movements and gestures. This syndrome most often occurs in people suffering from alcoholism. It belongs to the category of clouded consciousness syndromes and may indicate the development of schizophrenia or brain diseases.
4. Delusional excitement - develops as a result of the emergence of ideas of persecution, delusions, etc. People with this disorder are often very tense and aggressive. They can threaten and sometimes use force. Therefore, it is important for such patients to provide the correct therapy. This condition indicates schizophrenia, brain diseases and symptomatic psychoses.
5. Manic excitement - in this state, a person experiences an elevated mood, accelerated thought processes, an increased desire for action, fussiness, and inconsistent thinking. This condition often accompanies schizophrenia and is supplemented by delusions, hallucinations, and impaired consciousness.

Nervous overexcitement

Increased nervous excitement, as a rule, indicates a weakening of inhibitory nervous processes. According to the law of similarity, which forms the basis of homeopathic treatment, the potentized homeopathic preparation of caffeine Coffea cruda may be useful for an excited patient if the excitement is such that the limbs tremble, the person cannot cope with the influx of thoughts, nervous heartbeat and even a joyful mood, and sleep does not occur.

When the mental excitement is expressed by talkativeness, and the patient (usually a woman) appears lively and cheerful, but in reality it is a morbid condition, Lachesis and Cimicifuga are indicated.

Palladium and Sepia women are excited in company, but almost decompensated at home.

Excessive antasia - Belladonna, Cannabis indica, Hyosciamus, achesis. Stramonium.

A good remedy for painful excitation is potentized Camphor. Rhus has an unbalanced mood (internal restlessness, need for constant movement, as in the case of Chamomilla).

The drugs of choice for mental overexcitation are Aconitum, Anacardium, Argentum nitricum, Aurum, Causticum, Kalium bromatum, Opium, Moschus.

In severe cases of neurosis, obsessive ideas and sensations are formed (fear of space, animals, transport, public and performances, fear of illness, fear of imminent death).

With neurosis, in contrast to delirium, a critical attitude towards one’s condition is usually retained, and obsessive drives (for example, the desire to jump from a height) are usually not realized.

The leading remedy for a patient with truly obsessive ideas is Thuja: sometimes the patient believes that animals are moving in the stomach, sometimes the limbs are made of glass and will break. The patient constantly thinks about this and cannot get rid of these ideas, despite their absurdity.

The Argentum nitricum patient has an obsession with tall buildings falling on him in the street. If the patient feels as if his body and mind are separate, Anacardium or Tuja may help. An additional symptom for Anacardium is an obsessive feeling that the mind is being controlled by some superpower.

The Aurum metallicum patient is gloomy, constantly thinks about death and the extinction of life, and is depressed by a feeling of complete insignificance. Obsessions of a sexual nature are characteristic of Staphysagria (in contrast, in Sepia even the thought of sex makes her angry). The Silicea patient is consumed by an increased sense of responsibility, as well as a strange, persistent desire to sit on the floor and count small objects.

Clinical picture

Symptoms of psychomotor agitation depend on the causes of the disorder. External manifestations include the following:

• a sharp exacerbation of the main disease;
• inappropriate human behavior;
• increased irritability;
• body movements that are not typical for humans;
• emergence of suicidal tendencies;
• aggressive behavior;
• lack of control over one's behavior.

It is important to consider that patients in this condition pose a serious danger to others. That is why it is so important to promptly treat this pathology. Sometimes psychomotor agitation even leads to suicide.

Symptoms

There are many clinical signs of catatonic syndrome. Symptoms are often related to the motor area. With catatonic stupor, the patient becomes numb or completely immobile. Muscle tone is increased, especially in the head and shoulder girdle. The chewing muscles are toned, the lips are pulled forward (proboscis symptom), the person lies on his back, holding his head above the pillow (the “air cushion” symptom). Less severe conditions occur in the form of catalepsy. Muscle tone may alternate with complete relaxation, and epileptiform seizures are sometimes observed. The state of catatonic excitement is characterized by incoherent speech, absurd rhyming, and echolalia.

In severe cases, the attack of stupor with catalepsy is prolonged, mutism, lack of reaction of the pupils to intense painful stimuli (Bumke's symptom), and persistent insomnia are noted.

Stupor may be accompanied by oneiric stupefaction, delusions and hallucinations. Motor disturbances manifest themselves in combination with a feeling of stiffness of the body and the inability to move, with stupor, or a feeling of muscle looseness with motor excitement.

In catatonic states, the following symptoms may occur:

• catatonic stupor or substupor - complete or partial immobility, often in a sitting or standing position;
• catalepsy - a person remains in one position for a long time;
• waxy flexibility - long-term preservation of the position that another person gives the patient;
• negativism—resistance when another person tries to change the patient’s position;
• mutism – prolonged silence;
• stereotypy - repeated monotonous movements;
• catatonic agitation - increased disordered motor activity;
• echolalia/echopraxia - copying the words and movements of another person;
• pretentiousness of facial expressions and movements.

In addition to the main symptoms, manifestations of disruption of the autonomic nervous system may occur. With catatonia, there may be an increase in body temperature to subfebrile, a feeling of thirst, increased blood pressure, and tachycardia. Often patients refuse water and food.

The detailed picture of catatonic stupor and agitation does not differ in clinical manifestations in adolescents and adults. Oneiric catatonia often occurs against the background of the manic phase in schizoaffective psychosis; it is much less common in depression and attacks of fur-like schizophrenia, especially in adolescents. Hebephrenic syndrome is characteristic of adolescence and the malignant course of schizophrenia. As a rule, catatonic symptoms appear against the background of this syndrome.

Fibril catatonia develops with symptoms of oneiric, neurological and somatic disorders. A febrile attack is characterized by manic-delusional, hallucinatory and depressive syndromes. With more pronounced psychosis, fantastic delirium appears. The patient is in a state of agitation or stupor.

Body temperature rises sharply to febrile and higher. There is no relationship with somatic and infectious diseases. Blood pressure rises, tachycardia and increased sweating are present. The person is in an excited state and feels very thirsty. Excitement gives way to stupor or sub-stupor. General health worsens. The feeling of thirst and hunger disappears, the skin becomes dry, and swelling appears. If assistance is not provided in a timely manner, congestion in the lungs, bedsores and other complications may develop.

Most often, attacks of febrile catatonia are observed in people 41-50 years old. They are characterized by a severe course and a high risk of death.

With primary manifestations of catatonia, you should immediately consult a doctor. With timely diagnosis and effective treatment, the condition can be normalized without further development of complications.

Urgent Care

A patient in a state of psychomotor agitation requires urgent hospitalization in a psychiatric hospital. Therefore, if symptoms of this disease appear, you should immediately call a specialized ambulance.

If such a condition develops, first aid to the patient can only be provided by a psychiatrist. The primary treatment tactic is to urgently immobilize the person. To do this, it is fixed with wide bandages.

In difficult cases, doctors are assisted by law enforcement agencies. If it is possible to establish contact with the patient, the doctor should conduct an explanatory conversation with him. The patient must be told that he needs hospitalization and treatment in a psychiatric hospital.

Algorithm for providing emergency care for psychomotor agitation

Treatment in Re-Alt

When treating catatonia that has developed against the background of another mental or physical disorder, therapy is aimed mainly at the underlying disease. Therefore, it is very important for the effectiveness of treatment to conduct a thorough diagnosis. At the Re-Alt mental health center, specialists conduct a detailed analysis of each clinical case and assess the patient’s mental and somatic status in order to individually select treatment tactics.

The most effective method of treating catatonia is the use of drugs from the group of benzodiazepine tranquilizers. Pharmacotherapy helps reduce muscle tone and eliminate other manifestations of catatonia. Treatment uses drugs with sedative, anticonvulsant effects, and muscle relaxants.

If drug treatment is ineffective, electroconvulsive therapy may be prescribed.

Febrile catatonia is a medical emergency. Treatment is carried out inpatiently. Measures are prescribed to maintain and normalize the functioning of all body systems. Antibacterial therapy is prescribed to prevent complications. After stabilization of the condition, electroconvulsive therapy is performed

Health care

After the patient is hospitalized, he is prescribed emergency medication. At this stage, different types of tranquilizers are used, which quickly stop psychomotor agitation.

For this purpose, intravenous use of antipsychotics, which have pronounced sedative properties, is indicated. For example, a doctor may prescribe Levomepromazine at a dosage of 50-75 mg or Clozapine at a dosage of 50 mg.

One of the most effective means for relieving the symptoms of this condition is Aminazine. This drug must be administered intramuscularly. The dosage may vary - it all depends on the height, age and weight of the patient. The range is 25-100 mg. The use of this remedy is supplemented with the same volume of novocaine 0.25-0.5%. Thanks to this, the person quickly calms down and falls asleep.

Reducing the level of arousal should not lead to a decrease in the intensity of therapy or monitoring of the patient. The fact is that the disease can return with renewed vigor. In such a situation, the person will need to be helped again.

If the patient was previously seen by specialists with the same syndrome, its symptoms are relieved using the same drugs. However, in such a situation, double dosage is indicated.

Pathogenesis

There is no consensus on the pathogenesis of catatonia. Studies have shown that disruption of communication between cortical structures, the thalamus and the basal ganglia play an important role in the occurrence of catatonic symptoms, therefore, in addition to clinical assessment, when studying catatonia, it is worth taking into account the results of neuroimaging and neuropsychological examinations. The hypothesis is based on a lack of gamma-aminobutyric acid (GABA) in the basal ganglia. Normally, GABA reduces the intensity of emotional reactions, such as anger, fear or anxiety.

In modern literature, there are often cases of catatonia caused by abrupt withdrawal of drugs used to treat catatonic states and accompanying mental disorders. This therapy uses mechanisms to increase GABA activity in the basal ganglia, which has a positive therapeutic effect. With abrupt withdrawal of drugs, an increase in motor symptoms often occurs (the phenomenon of “rebound catatonia”).

It is possible that catatonia develops as a result of severe anxiety, in response to stress. Therefore, scientists suggest that catatonic states are directly related to affective and other mental disorders that are accompanied by symptoms of severe anxiety.

Danger and prognosis

Provided that the symptoms of the disease are properly and timely relieved, psychomotor agitation does not pose a threat to the life or health of the patient. After eliminating the manifestations of the disease, the prognosis fully corresponds to the prognosis of the underlying pathology.

The greatest danger is posed by patients who have obvious catatonic and hallucinatory-delusional types of arousal. They are accompanied by unpredictable actions that can cause harm to the patient himself and others.

Psychomotor agitation is a rather dangerous condition that can pose a danger to the health of the person himself and those around him. Therefore, in such a situation, you must call an ambulance.

Use of drugs depending on the type of psychosis

As a rule, a newly admitted patient is prescribed general sedatives, but after the diagnosis has been clarified, further relief of psychomotor agitation will directly depend on its type. Thus, for hallucinatory-delusional excitation, the drugs “Haloperidol” and “Stelazine” are prescribed, and for manic arousal, the drugs “Clopixol” and “Lithium Oxybutyrate” are effective. The reactive state is relieved with the drugs "Aminazin", "Tizercin" or "Phenazepam", and catotonic agitation is cured with the drug "Mazhepril".

Specialized medications are combined, if necessary, with general sedatives, adjusting the dose.