Eficacia del tratamiento para las personas agitadas en situaciones de emergencia en comparación con los servicios comunitarios:  revisión sistemática

Maria Terezinha Zeferino; Marcelo Brandt Fialho; Silvana Silveira Kempfer; Gabriela Marcellino de Melo Lanzoni

Maria Terezinha Zeferino Departamento de Enfermagem – NFR, Universidade Federal de Santa Catarina – UFSC (Brasil)
Marcelo Brandt Fialho Departamento de Enfermagem – NFR, Universidade Federal de Santa Catarina – UFSC (Brasil)
Silvana Silveira Kempfer Departamento de Enfermagem – NFR, Universidade Federal de Santa Catarina – UFSC (Brasil)
Gabriela Marcellino de Melo Lanzoni Departamento de Enfermagem – NFR, Universidade Federal de Santa Catarina – UFSC (Brasil)

Palabras clave: Revisión, Salud Mental Pública, Emergencias, Intervención en crisis

Key-words: Review, Public Mental Health, Emergencies, Crisis Intervention

Resumen

Objetivo: Conocer la eficacia del tratamiento de personas con conducta hetero agresiva en los servicios de urgencias en comparación con los servicios de salud comunitarios. Método: Revisión sistemática de estudios en bases de datos: LILACS, Psychinfo, Scopus, Web de Ciencia, PUBMED y literatura gris en Google Scholar y en la lista de referencias. La búsqueda se realizó en junio de 2016. Dos mil ciento sesenta estudios fueron encontrados y seis de estos estudios fueron seleccionados para su análisis después de la aplicación de los criterios de exclusión. Resultados: El acercamiento a individuos con comportamiento agitado, agresivo o violento ocurre con mayor frecuencia en servicios de emergencia general y psiquiátrica con intervención médica. Los medicamentos utilizados para controlar la agitación y la sedación fueron benzodiazepina (midazolam, lorazepam), antihistamínico (prometazina), antipsicóticos típicos (haloperidol y droperidol) y antipsicóticos atípicos (olanzapina, ziprasidona, risperidona y quetiapina). Conclusión: Todos los fármacos evaluados promueven la sedación, pero esta revisión muestra ventajas en el uso de la combinación de haloperidol más prometazina.

Abstract

Objective: To know the effectiveness of the treatment of people with hetero aggressive behavior in emergency departments compared with community health services. Method: Systematic review of studies in databases: LILACS, Psychinfo, Scopus, Web of Science, PUBMED and gray literature in Google Scholar and in the reference list. The search was conducted in June 2016. Two thousand one hundred and sixty studies were found, and six of these studies were selected for analysis after the application of exclusion criteria. Results: The approach to individuals with agitated, aggressive or violent behavior occurs most often in general and psychiatric emergency services with medical intervention. Medications used to control agitation and for sedation were benzodiazepine (midazolam, lorazepam), antihistamine (promethazine), typical antipsychotics (haloperidol and droperidol), and atypical antipsychotics (olanzapine, ziprasidone, risperidone and quetiapine). Conclusion: All evaluated drugs promote sedation, but this review shows advantages in the use of haloperidol plus promethazine combination.

Bibliografía

1. Martel M, Miner J, Fringer R, et al. Discontinuation of droperidol for the control of acutely agitated out-of-hospital patients. Prehosp Emerg Care [internet]. 2005 Jan-Mar [cited 2017 Apr 26]; 9(1):44-8. Available from: http://www.tandfonline.com/doi/full/10.1080/10903120590891723?scroll=top&needAccess=true
2. Brennaman L. Crisis emergencies for individuals with severe, persistent mental illnesses: a situation-specific theory. Arch Psychiatr Nurs [internet]. 2012 Aug [cited 2017 Apr 26]; 26(4):251-60. Available from: http://ac.els-cdn.com/S0883941711001579/1-s2.0-S0883941711001579-main.pdf?_tid=6bd0d44e-2c0e-11e7-8bea-00000aab0f02&acdnat=1493382790_ea8383c0d1447b46c6e628dfb52c4723
3. Waszynski C, Veronneau P, Therrien K, Brousseau M, Massa A, Levick S. Decreasing Patient Agitation Using Individualized Therapeutic Activities. Am J Nurs [internet]. 2013 Oct [cited 2017 Apr 26];113(10):32-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24037247
4. Escobar R, San L, Perez V, et al. Effectiveness results of olanzapine in acute psychotic patients with agitation in the emergency room setting: results from Natura study. Actas Esp Psiquiatr [internet] 2008 [cited 2017 Apr 26]; 36(3):151-7. Available from: http://www.actaspsiquiatria.es/repositorio//9/51/ENG/9-51-ENG-151-157-745008.pdf
5. Burk RS, Grap MJ, Munro CL, Schubert CM, Sessler CN. Predictors of agitation in critically ill adults. Am J Crit Care [internet]. 2014 Sep[cited 2017 Apr 26]; 23(5):414-23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451811/pdf/nihms693124.pdf
6. Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapid tranquillisation of violent or agitated patients in a psyquiatric emergency setting. Br J Psychiatry [internet] 2004[cited 2017 Apr 26];185, 63-9. Available from: http://bjp.rcpsych.org/content/bjprcpsych/185/1/63.full.pdf
7. Baldaçara L, Sanches M, Cordeiro DC, Jackowski AP. Rapid Tranquilization for agitated patients in emergency psyquiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol pluz midazolam and haloperidol alone. Rev Bras Psiquiatr[internet] 2011 [cited 2017 Apr 26]; 33(1):30-9. Available from: http://www.scielo.br/pdf/rbp/v33n1/v33n1a08.pdf
8. Chan EW, Taylor DM, Knott JC, Phillips GA, Castle DJ, Kong DCM. Intravenous droperidol or olanzapine as an adjunct to midazolam for the acutely agitated patient: a multicenter, randomized, double-blind, placebo-controlled clinical trial. Ann Emerg Med [internet]. 2013[cited 2017 Apr 26];61(1):72-81. Available from: http://ac.els-cdn.com/S0196064412013674/1-s2.0-S0196064412013674-main.pdf?_tid=5da0b6b8-2c0f-11e7-8c57-00000aab0f01&acdnat=1493383196_a7ad9a9d24c0243f0d07fea23bf5e4ee
9. Kinon BJ, Ahl J, Rotelli MD, McMullen E. Efficacy of accelerated dose titration of olanzapine with adjunctive lorazepam to treat acute agitation in schizophrenia. Am J Emerg Med [internet]. 2004 [cited 2017 Apr 26]; 22(3):181-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15138953
10. Martel M, Sterzinger A, Miner J, Clinton J, Biros M. Manangement of acute undifferentiated agitation in the emergency department: a randomized double-blind trial droperidol, ziprasidone, and midazolam. Acad Emerg Med [internet]. 2005[cited 2017 Apr 26]; 12 (12):1167-72. Available from: http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2005.07.017/epdf
11. Villari V, Fonzo V, Montemagni C, Pandullo P, Bogetto F. Oral risperidone, olanzapine and quetiapine versus haloperidol in psychotic agitation. Prog Neuropsychopharmacol Biol Psychiatry[internet] . 2008 Feb [cited 2017 Apr 26]; 15;32(2):405-13. Available from: http://ac.els-cdn.com/S0278584607003375/1-s2.0-S0278584607003375-main.pdf?_tid=c6000ee8-2c0f-11e7-afbd-00000aab0f27&acdnat=1493383371_2e882f919bab95615dac54e5d939be69
12. Richmond JS, Berlin JS, Fishkind AB, et al. Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med[internet] . 2012 Feb [cited 2017 Apr 26]; 13(1):17-25. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298202/pdf/wjem-13-01-17.pdf
13. Leckey DK. Ten strategies to extinguish potentially explosive behavior. Nursing [internet]. 2011[cited 2017 Apr 26]; 55-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21765331
14. Mantovani C, Migon MN, Alheira FV, Del-Bem CM. Agitated or aggressive patient management. Rev Bras Psiquiatr[internet]. 2010 [cited 2017 Apr 26]; 32( Supl II): 94-103. Available from: http://www.scielo.br/pdf/rbp/v32s2/en_v32s2a06.pdf
15. Hopper AB, Wilke GM, Castillo EM, Campillo A, Davie T, Wilson MP. Ketamine use for acute agitation in the emergence department. J Emerg Department [internet]. 2015 [cited 2017 Apr 26]; 48(6):712-9. Available from: http://ac.els-cdn.com/S073646791500147X/1-s2.0-S073646791500147X-main.pdf?_tid=552c77dc-2c10-11e7-bb59-00000aab0f6c&acdnat=1493383611_7141cde2928f8a2dccf49d4581ff60ed
16. Tyler K, Hirsch CH, Scher LM, Stevenson DE. Emergency Medicine Settings. In: On-Call Geriatric Psychiatry. Springer International Publishing. Switzerland. 2016; pp 219-30.
17. Scheppke KA, Braghiroli J, Shalaby M, Chait R. Prehospital use of IM Ketamine for sedation of violent and agitated patients. West J Emerg Med[internet]. 2014 Nov [cited 2017 Apr 26]; 15(7):736-41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251212/pdf/wjem-15-736.pdf
18. Cole JB, Moore JC, Nystrom PC, et al. A prospective study of ketamine versus haloperidol for severe prehospital agitation. Clinic Toxicol [internet]. 2016 [cited 2017 Apr 26]; 54(7):556-62. Available from: http://www.tandfonline.com/doi/pdf/10.1080/15563650.2016.1177652?needAccess=true
19. Mcdonald K, Wilson MP, Minassian A, et al. A retrospective analysis of intramuscular haloperidol and intramuscular olanzapine in the treatment of agitation in drug-and-alcohol-using patients. General Hospital Psychiatry [internet]. 2010 [cited 2017 Apr 26]; 32:443-5. Available from: http://ac.els-cdn.com/S0163834310000952/1-s2.0-S0163834310000952-main.pdf?_tid=fc91f880-2c10-11e7-b971-00000aacb361&acdnat=1493383892_3f1fe2a0f774874ab81b0e2c056ab63f
20. Malloy-Diniz FL, Mattos P, Abreu N, Fuentes D, organizadores. Neuropsicologia: aplicações clínicas. Porto Alegre: Artmed, 2016.
21. Honiden S, Siegel MD. Managing the agitated patient in the ICU: sedation, analgesia, and neuromuscular blockade. J Intens Care Med [internet]. 2010 [cited 2017 Apr 26]; 25(4):187-204. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0885066610366923
22. Huf G, Coutinho ES, Adams CE. TREC-Rio trial: a randomized controlled trial for rapid tranquillisation is agitated Patients in psychiatric emergency rooms [ISRCTN44153243]. BMC Psychiatry [internet]. 2002 [cited 2017 Apr 26]; 2:11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC134470/pdf/1471-244X-2-11.pdf

Eficacia del tratamiento para las personas agitadas en situaciones de emergencia en comparación con los servicios comunitarios: revisión sistemática

Effectiveness of treatment to agitated people in emergencies compared to community services: systematic review

Resumen

Abstract

Bibliografía