目的:开发一种减少和预防躁动的算法,旨在指导国际精神病学协会(IPA)制定的躁动定义的实施。
方法:回顾有关治疗指南和推荐算法的文献;通过反复整合研究信息和专家意见进行算法开发。
方法:IPA鼓动工作组。
方法:IPA国际激越专家小组。
方法:将可用信息整合到一个综合算法中。
方法:无。
结果:IPA鼓动工作组建议调查,计划,以及减少和预防躁动的行动(IPA)方法。对行为进行彻底调查后,进行计划和行动,重点是共同决策;根据需要评估和调整计划的成功。重复该过程,直到搅拌降低到可接受的水平,并优化复发的预防。心理社会干预是每个计划的一部分,并在整个过程中持续进行。药物干预分为夜间/昼夜节律躁动的选择小组;轻度-中度躁动或具有突出情绪特征的躁动;中度-重度躁动;严重躁动,对患者或其他人有危险伤害。每个小组都提供了治疗替代方案。在各种场所-家庭中发生的躁动,疗养院,急诊科,介绍了临终关怀和治疗方法的调整。
结论:IPA对躁动的定义被实施为一种躁动管理算法,该算法强调社会心理和药物干预的整合,对治疗反应的反复评估,调整治疗方法以反映临床情况,共同决策。
OBJECTIVE: To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA).
METHODS: Review of literature on treatment
guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion.
METHODS: IPA Agitation Workgroup.
METHODS: IPA panel of international experts on agitation.
METHODS: Integration of available information into a comprehensive algorithm.
METHODS: None.
RESULTS: The IPA Agitation Work Group recommends the Investigate, Plan, and Act (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and acting with an emphasis on shared decision-making; the success of the plan is evaluated and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Psychosocial interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal/circadian agitation; mild-moderate agitation or agitation with prominent mood features; moderate-severe agitation; and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a variety of venues-home, nursing home, emergency department, hospice-and adjustments to the therapeutic approach are presented.
CONCLUSIONS: The IPA definition of agitation is operationalized into an agitation management algorithm that emphasizes the integration of psychosocial and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision-making.