Occurrence Of Agitation Research Articles

Reduction and prevention of agitation in persons with neurocognitive disorders: an international psychogeriatric association consensus algorithm.

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). Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion. IPA Agitation Workgroup. IPA panel of international experts on agitation. Integration of available information into a comprehensive algorithm. None. 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. 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.

Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department.

Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department.

Evaluation of Neuropsychiatric Complications in Hospitalized COVID-19 Patients.

Previous research has shown that COVID-19 patients are at risk of developing mental disorders. Limited number of studies about psychiatric and neuropsychiatric presentations in hospitalized COVID-19 patients is currently available. Subjects were 172 patients diagnosed with COVID-19 and requiring inpatient care, hospitalized at reprofiled clinics of the university hospital. The study aimed to quantify psychiatric symptoms, and determine correlations with agitation, BMI, mortality, and other variables (age, sex, oxygen therapy, intubation, etc.). Mental disorders due to known physiological conditions were of highest prevalence (n=105, 62.9%), followed by anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (n=34, 20.4%), and dementia (n=21, 12.6%) in COVID-19 patients. Depressive disorders (n=13, 7.9%), alcohol related disorders associated with withdrawal symptoms (n=10, 6%), and schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (n=4, 2.4%) were less common. Patients diagnosed with mental disorders due to known physiological conditions were significantly older compared to patients with other diagnoses. The depression was observed more commonly in patients treated with high-flow nasal oxygen (HFNO), and patients disconnected from invasive mechanical ventilation (IMV). Mixed anxiety-depressive symptoms were observed in 23.8% of the patients (n=41), and they were more prevalent in younger patients compared to patients without anxiety-depressive symptoms. Agitated patients were significantly older than non-agitated patients. No connection was observed between the occurrence of agitation and treatment with HFNO, nor in case of patients disconnected from IMV; however, the relationship between agitation and death proved to be statistically significant (OR = 5.9, 95% CI 2.33-15.29). Analysis of psychiatric and neuropsychiatric presentations in COVID-19 patients and their correlation with multiple variables provides a better understanding of the effect of infection on mental health, and brings forth a necessity of transdisciplinary approach in handling COVID-19 patients.

Reduction and Prevention of Agitation in Patients with Neurocognitive Disorders: An International Psychogeriatric Association Consensus Algorithm

AbstractBackgroundThe International Psychogeriatric Association (IPA) extends its commitment to serving those with psychiatric and behavioral manifestation in the presence of cognitive impairment and dementia with this introduction of an agitation reduction and prevention algorithm that builds on the definition of agitation developed by IPA.MethodThis presentation describes a review of literature, treatment guidelines, to recommend an algorithm for care and a reiterative integration of expert opinion within the context of an IPA Agitation Work group, a panel of international experts on agitation. The outcome is an integration of available information into a comprehensive algorithm.ResultThe IPA Agitation Work Group recommends the Investigate, Plan, and Assess (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and implementation with an emphasis on shared decision‐making; the success of the plan in assessed and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Nonpharmacologic interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal 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 different venues is considered (home, nursing home, emergency depaThe IPA definition of agitation is operationalized into an agitation management algorithm emphasizing the integration of non‐pharmacologic and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision‐making. rtment, hospice), with adjustments to the therapeutic approach.ConclusionThe IPA definition of agitation is operationalized into an agitation management algorithm emphasizing the integration of non‐pharmacologic and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision‐making.

Comparative Analysis of the Anesthesia Effect of Cisatracurium Besylate and Mivacurium Chloride Otolaryngology Surgery.

Objective The aim is to investigate and compare the anesthesia effect of cisatracurium besylate and mivacurium chloride otolaryngology surgery. Materials and Methods 108 patients who underwent ENT surgery under general anesthesia in our hospital from November 2021 to March 2022 were recruited for retrospective analysis, in which patients in the experimental group A were anesthetized with cisatracurium besylate and patients in the experimental group B were anesthetized with mivacurium, and the anesthetic effects and recovery of the two groups were compared and analyzed. Results There was no significant difference in mean arterial pressure, heart rate, and pulse oximetry levels between the two groups at the six time points of admission, anesthesia induction, intubation, end of operation, recovery of consciousness, and extubation (all P > 0.05). The train of four stimulation values at end of operation, recovery of consciousness, and extubation were significantly higher than those of the experimental group A (all P > 0.05). The recovery time of self-consciousness, extubation time, and eye-opening time of the experimental group B were significantly shorter than those of the experimental group A, and the occurrence of agitation was significantly less than that of the experimental group A (all P > 0.05). The total incidence of adverse conditions in the experimental group B was significantly lower than that in the experimental group A (P > 0.05). Conclusion Compared with cisatracurium besylate in otolaryngology surgery, mivacurium chloride anesthesia offers a promising route with respect to less impact on hemodynamics, faster postoperative recovery, absence of the accumulation of neuromuscular blockade, less adverse reactions, and higher safety.

Electroencephalogram Signatures of Agitation Induced by Sevoflurane and Its Association With Genetic Polymorphisms

Background: Volatile anesthetic-induced agitation, also called paradoxical excitation, is not uncommon during anesthesia induction. Clinically, patients with agitation may lead to self-injury or disrupt the operative position, increasing the incidence of perioperative adverse events. The study was designed to investigate clinical features of sevoflurane-induced agitation and examined whether any gene polymorphisms can potentially be used to predict agitation.Methods: One hundred seventy-six patients underwent anesthesia induction with sevoflurane were included in this study. Frontal electroencephalogram (EEG), electromyography (EMG), and hemodynamics were recorded continuously during anesthesia induction. DNA samples were genotyped using the Illumina Infinium Asian Screening Array and the SNaPshot technology. Genetic association was analyzed by genome-wide association study. Logistic regression analysis was used to determine the role of variables in the prediction of agitation.Results: Twenty-five (14.2%) patients experienced agitation. The depth of anesthesia index (Ai index) (p < 0.001), EMG (p < 0.001), heart rate (HR) (p < 0.001), and mean arterial pressure (MAP) (p < 0.001) rapidly increased during the agitation. EEG exhibited a shift toward high frequencies with spikes during agitation. The fast waves (alpha and beta) were more pronounced and the slow rhythms (delta) were less prominent during the occurrence of agitation. Moreover, three SNPs in the methionine synthase reductase (MTRR) gene were correlated to the susceptibility to agitation (p < 5.0 × 10−6). Carrying rs1801394 A > G (odds ratio 3.50, 95% CI 1.43–9.45) and/or rs2307116 G > A (3.31, 1.36–8.95) predicted a higher risk of agitation.Discussion: This study suggests that the agitation/paradoxical excitation induced by sevoflurane is characterized as increases in Ai index, EMG, HR and MAP, and the high frequency with spikes in EEG. Moreover, our results provide preliminary evidence for MTRR genetic polymorphisms, involving folate metabolism function, may be related to the susceptibility to agitation.Clinical Trial Number and Registry URL: ChiCTR1900026218; http://www.chictr.org.cn/showproj.aspx?proj=40655.

Risk factors for emergence agitation in adults after general anesthesia: A systematic review and meta-analysis.

Emergence agitation (EA) is an adverse post-operative complication that increases the risk for injury, self-extubation, hemorrhages, and prolonged hospitalization. This meta-analysis aims to define the risk factors for adult EA after general anesthesia and provide recommendations for clinical practice. Embase, PubMed, Medline, and the Cochrane Library databases were comprehensive retrieved. Observational studies that reported the risk factors for adult EA were enrolled. Review Manager 5.4 was used to analyze the extracted data. Eighteen observational studies involving 16, 678 adult patients were enrolled in this study. Eighteen pre-operative and nineteen intraoperative factors with unadjusted data, and five pre-operative and five intraoperative factors with adjusted data were meta-analyzed separately. Among them, seven factors (age, male, smoking, history of substance misuse, inhalational anesthesia, urinary catheter, complain of pain, or need analgesic drug use in post-anesthetic care unit) were the risk factors no matter meta-analyzed by unadjusted data or adjusted data. Intraoperative use of benzodiazepines was the risk factor when meta-analyzed by adjusted data, but not unadjusted data. Moreover, age and inhalational anesthesia were not the risk factors when omitted one study for sensitivity analysis, and history of substance misuse could not do sensitivity analysis. Based on this meta-analysis, male, smoking, urinary catheter, and post-operative pain are the risk factors, while age, inhalational anesthesia, history of substance misuse, and intraoperative use of benzodiazepines are the possible risk factors for adult EA. This systematic review and meta-analysis identify risk factors associated with the occurrence of agitation during emergence from general anesthesia. As might be expected, the strongest factors are generally things which are irritating or painful for patients, but cannot necessarily be avoided.

Analysis on the Anesthesia Effects of Sevoflurane and Propofol on Laparoscopic Cholecystectomy

To compare the anesthesia effects of propofol and sevoflurane in laparoscopic cholecystectomy. 60 patients with laparoscopic cholecystectomy in our hospital from January 2019 to June 2020 were randomly divided into control group and observation group, 30 cases in each group. The control group was given total intravenous anesthesia (continuous infusion of propofol 6-8 mg/kg/h during operation), while the observation group was given intravenous inhalation combined anesthesia (continuous inhalation of 1-2.5 % sevoflurane during operation). The vital signs, anesthesia time, recovery time and extubation time of the two groups after induction and at the end of operation were compared and the occurrence of agitation during anesthesia recovery period was recorded The changes of heart rate and blood pressure before and after agitation were analyzed. The results showed that there was no significant difference in anesthesia time, recovery time and extubation time between the two groups (p>0.05); there was no significant difference in body temperature, oxygen saturation, mean arterial pressure and heart rate between the two groups after induction and at the end of operation (p>0.05); compared with the control group, the average agitation score of the observation group was significantly higher and the difference was statistically significant (p<0.05). There were 6 cases of restlessness in the control group (6/30) and 14 cases of restlessness in the observation group (14/30), the difference between the two groups was statistically significant (p<0.05); before and after the emergence of restlessness, the blood pressure fluctuation rate and heart rate fluctuation rate changed significantly and the blood oxygen saturation decreased, with significant difference (p<0.05). Sevoflurane inhalation anesthesia is more prone to emergence agitation than propofol intravenous infusion anesthesia. Intravenous anesthesia and inhalation anesthesia have their own advantages. If we fully grasp and make use of their characteristics in our work, we will make the patients wake up more smoothly and the anesthesia work more efficiently.

Effect of nursing intervention on incidence of agitation and negative emotion in patients recovering from general anesthesia in operating room

Objective To investigate the effect of nursing intervention on the incidence of agitation and negative emotion in patients undergoing general anesthesia recovery. Methods Totally 120 patients with general anesthesia admitted to the Binzhou Central Hospital, Shandong Province from January 2017 to January 2019 were divided into the control group and the observation group by random digits table method with 60 cases each. Those in the control group was given routine nursing, the observation group was given integrated care. The incidence rate of agitation, conscious recovery time, the time of wake-up score≥4 and negative emotional changes in the two groups were compared. Results The incidence of agitation in the observation group was 6.67% (4/60), which was lower than that in the control group (25.0%, 15/60). The difference was statistically significant (χ2 value was 6.253, P<0.05). The conscious recovery time, the time of wake-up score≥4 was (1.05±0.39), (16.34±1.21) h, both were shorter than the control group (2.68±0.42), (23.12±1.03) h, the difference was statistically significant (t value was 22.029, 33.050, P<0.01). The Kessler10 score of the observation group was 30.24±3.64,which was lower than that in the control group 24.84±2.35. The difference was statistically significant (t value was 9.654, P<0.01). Conclusions The operation room nursing intervention for patients with general anesthesia recovery can reduce the occurrence of agitation and reduce the negative emotion of patients, and the application effect is remarkable. Key words: Operating room; Nursing care; General anesthesia recovery; Agitation; Negative emotion

Efficacy of combination of multiple measures in preventing agitation during recovery from general anesthesia in preschool children

Objective To evaluate the efficacy of combination of multiple measures in preventing agitation during recovery from general anesthesia in the preschool children. Methods Four hundred and fifty preschool pediatric patients of both sexes, aged 3-6 yr, weighing 16-25 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective monocular strabismus surgery, were divided into 3 groups (n=150 each) using a random number table method: routine prevention group (groupⅠ), midazolam-routine prevention group (groupⅡ) and cartoon video-assisted admission to operating room-family members accompanying in postanesthesia care unit (PACU)-routine prevention group (group Ⅲ). Dexmedetomidine 0.3 μg/kg was intravenously infused over 10 min in groupⅠ.On the basis of groupⅠ, midazolam 0.05 mg/kg was intravenously infused in the holding area in group Ⅱ, and children were admitted to the operating room while they were watching cartoons selected by themselves when accompanied by family members, and they were also accompanied by family members in PACU in group Ⅲ.The modified Yale Preoperative Anxiety Scale score on admission to the operating room, Induction Compliance Checklist score, occurrence and degree of agitation during the recovery period, emergence time and duration of PACU stay were recorded. Results Compared with groupⅠ, the modified Yale Preoperative Anxiety Scale score on admission to the operating room and Induction Compliance Checklist score were significantly decreased, and the incidence of agitation during the recovery period (25.3% in group Ⅰ, 12.0% in group Ⅱ, 3.3% in group Ⅲ) was decreased in Ⅱ and Ⅲ groups , and the emergence time and duration of PACU stay were significantly prolonged in groupⅡ (P 0.05). Conclusion Cartoon video-assisted admission to operating room-family members accompanying in PACU-routine prevention can effectively prevent the occurrence of agitation during recovery from general anesthesia in the preschool children. Key words: Child, preschool; Anesthesia, general; Anesthesia recovery period; Agitation

Effect of parecoxib combined with ropivacaine for incision infiltration on agitation during recovery from anesthesia in patients undergoing abdominal hepatectomy

Objective To evaluate the effect of parecoxib combined with ropivacaine for incision infiltration on agitation during recovery from anesthesia in patients undergoing abdominal hepatectomy. Methods Forty patients of both sexes, aged 35-64 yr, with body mass index of 18-24 kg/m2, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, undergoing elective partial hepatectomy, were divided into parecoxib sodium group (group P) and parecoxib sodium plus ropivacaine group (group RP) with 20 cases in each group. Parecoxib sodium 40 mg was intravenously injected at 30 min before operation in group P. Parecoxib sodium 40 mg was intravenously injected at 30 min before operation, and incision infiltration was performed with 0.5% ropivacaine 20 ml at the end of surgery in group RP.Patient-controlled intravenous analgesia was performed at the end of surgery in both groups.The development of agitation, respiratory depression and nausea and vomiting was recorded within 30 min after operation.Blood samples were collected from the radial artery immediately before induction (T0), at the end of surgery (T1) and at removal of extubation (T2) for determination of plasma cortisone (Cor) concentrations (by radio-immunity method), plasma epinephrine (E) and norepinephrine (NE) concentrations (by enzyme-linked immunosorbent assay) and blood glucose (using a blood gas analyzer). Results Compared with the baseline at T0, the plasma concentrations of Cor, Glu, E and NE were significantly increased at T1, 2 in two groups (P>0.05). The incidence of agitation and plasma concentrations of Cor, Glu, E and NE were significantly lower at T1, 2 in group RP than in group P (P<0.05). No patients developed nausea and vomiting and respiratory depression in two groups. Conclusion Parecoxib combined with ropivacaine for incision infiltration can decrease the occurrence of agitation during recovery from anesthesia, which is related to inhibiting stress responses of patients undergoing abdominal hepatectomy. Key words: Cyclooxygenase 2 inhibitors; Amides; Anesthesia recovery period; Dysphoria

Loxapine to control agitation during weaning from mechanical ventilation

BackgroundWeaning from mechanical ventilation (MV) may be impeded by the occurrence of agitation. Loxapine has the ability to control agitation without affecting spontaneous ventilation. The aim of this study was to establish whether loxapine would reduce MV weaning duration in agitated patients.MethodsWe performed a multicentre, double-blind, placebo-controlled, parallel group, randomised trial. Patients who were potential candidates for weaning but exhibited agitation (Richmond Agitation-Sedation Scale score ≥ 2) after sedation withdrawal were randomly assigned to receive either loxapine or placebo. In case of severe agitation, conventional sedation was immediately resumed. The primary endpoint was the time between first administration of loxapine or placebo and successful extubation.ResultsThe trial was discontinued after 102 patients were enrolled because of an insufficient inclusion rate. Median times to successful extubation were 3.2 days in the loxapine group and 5 days in the placebo group (relative risk 1.2, 95% CI 0.75–1.88, p = 0.45). During the first 24 h, sedation was more frequently resumed in the placebo group (44% vs 17%, p = 0.01).ConclusionsIn this prematurely stopped trial, loxapine did not significantly shorten weaning from MV. However, loxapine reduced the need for resuming sedation.Trial registrationClinicaltrials.gov, NCT01193816. Registered on 26 August 2010.

Inhalation Anaesthesia a Cause for Delirium? A Case Report

Inhalation anaesthesia has been cause emergence delirium and agitation. Sevoflurane is the induction agent of choice for children and offers better clinical outcomes but on the other hand the most common vapour based anaesthesia with sevoflurane is associated with the highest incidence of delirium. We report an occurrence of agitation after sevoflurane anaesthesia in an adult patient for whom dexmetedotimidine was used to treat emerge agitation. His agitation, disorientation lasted for hours and under sedation infusion transferred to the intensive care unit (ICU). After 4 h later in ICU he remained calm and cooperative. A day later he was discharged to the ward uneventful.

Comparison of anesthetic efficacy of ketamine versus sevoflurane for foreskin ligation in pediatric patients

Objective To compare the anesthetic efficacy of ketamine and sevoflurane for foreskin ligation in the pediatric patients. Methods A total of 120 pediatric patients, aged 2-6 yr, weighing 10-18 kg, scheduled for elective foreskin ligation, were equally and randomly divided into ketamine group (group K) and sevoflurance group (group S). In group K, atropine 0.25 mg/kg and ketamine 2 mg/kg were injected intravenously, and foreskin ligation was performed after loss of eyelash reflex.In group S, 8% sevoflurance was inhaled using the tidal volume technique, the concentration inhaled was adjusted to 4% after loss of eyelash reflex, and then foreskin ligation was performed.The occurrence of crying before and during anesthesia induction, induction time, emergence time, occurrence of agitation during emergence from anesthesia and duration of agitation were recorded. Results Compared with group K, the rate of crying was significantly decreased, the emergence time was shortened (P 0.05). Conclusion Sevoflurance provides better anesthetic efficacy than ketamine when applied for foreskin ligation in the pediatric patients. Key words: Ketamine; Anesthetics, inhalation; Child; Ambulatory surgical procedures

Loxapine to control agitation during weaning from mechanical ventilation: a randomized controlled trial

Weaning from prolonged mechanical ventilation (MV) in the ICU may be impeded by the occurrence of agitation. Loxapine had the ability to control agitation without affecting the efficacy of spontaneous ventilation in an observational study, justifying the implementation of a randomized controlled trial.

Intoxication aiguë par cannabis chez un nourrisson de 10 mois

We describe a case of accidental cannabis poisoning in a 10-month-old girl, who presented with impaired consciousness, with drowsiness and restlessness, generalized hypotonia, and inadequate smiles. No circulatory or respiratory problems were observed. Initial investigations were not informative (blood biology, CT scan, and cerebrospinal fluid examination), while the main causes of coma (meningoencephalitis, head trauma, metabolic disorders) were excluded. Questioning the parents led to suspecting accidental ingestion of a piece of cannabis, which was confirmed by the detection of high blood and urine levels of cannabinoid derivatives. Management was symptomatic and the clinical course, marked by the occurrence of agitation and irritability episodes lasting up to H18, led to complete regression of symptoms. Because of the high consumption in France, pediatric poisoning by cannabis seems increasingly common. The toxic levels in children are unknown however. Diagnosis is based on questioning and the search for cannabinoid derivatives in urine. In children, clinical symptoms are more expressive compared to adults, with neurological (drowsiness, agitation, abnormal behavior, ataxia, hypotonia, coma, and convulsions) or cardiopulmonary (tachycardia, bradypnea, apnea) or homeostatic presentations (hypothermia). Treatment in children is essentially symptomatic but sometimes requires active resuscitation. Recommendations are based on clinical monitoring the first 24h after intoxication and on medicosocial support.

Escalas de Ramsay e Richmond são equivalentes para a avaliação do nível de sedação em pacientes gravemente enfermos

The main purpose of this study was to compare performance of the Ramsay and Richmond sedation scores on mechanically ventilated critically ill patients, in a university-affiliated hospital.This was a 4-month prospective study, which included a total of 45 patients mechanically ventilated, with at least 48 hours stay in the intensive care unit. Each patient was assessed daily for sedation mode, sedative and analgesic doses and sedation level using the Ramsay and Richmond scores. Statistical analysis was made using Student's t-test, Pearson's and Spearman's correlation, and constructing ROC-curves.A high general mortality of 60% was observed. The length of sedation and daily dose of medication did not correlate with mortality. Deep sedation (Ramsay > 4 or Richmond < -3) was positively correlated with probability of death with an AUC > 0.78. An adequate level of sedation (Ramsay 2 to 4 or Richmond 0 to -3) was sensitively correlated with probability of survival with an AUC > 0.80. A low level of sedation was observed in 63 days evaluated (8.64%), and no correlation was found between occurrence of agitation and unfavorable outcomes. Correlation between Ramsay and Richmond scores (Pearson's > 0.810 - p<0.0001) was good.In this study, Ramsay and Richmond sedation scores were similar for the assessment of deep, insufficient and adequate sedation. Both have good correlation with mortality in over sedated patients.

Role of agitation in prediction of outcomes after traumatic brain injury.

To determine the role of agitation in the prediction of traumatic brain injury rehabilitation outcomes. A longitudinal study of 340 consecutive patients admitted to an acute traumatic brain injury rehabilitation unit was conducted. Outcomes under study included rehabilitation length of stay, discharge destination, functional independence at discharge (FIM instrument), productivity at 1-yr follow-up, and life satisfaction at 1-yr follow-up (Satisfaction with Life Scale). Univariate analyses suggested that the presence of agitation in rehabilitation is predictive of a longer length of stay and decreased functional independence in the cognitive realm at discharge. In addition, individuals who exhibit agitation at any time during rehabilitation are less likely to be discharged to a private residence. However, multivariate analyses indicated that cognitive functioning at admission to rehabilitation (FIM cognitive) mediates the relationship between the presence of agitation and length of rehabilitation, as well as between agitation and FIM cognitive at discharge. Similar results were found when discharge residence was the dependent variable; however, agitation also contributed some unique variance to the prediction. Lower cognitive functioning at admission to rehabilitation was associated with the occurrence of agitation during rehabilitation, longer length of stay, lower cognitive functioning at discharge, and a decreased likelihood that an individual would be discharged to a private residence. The results of the multivariate analyses support the contention that agitation and cognition are intimately related, with the long-term effects of the former being at least partially driven by the latter. These findings support the importance of systematically monitoring both agitation and cognition when applying interventions to reduce agitation.

Factor structure of the agitated behavior scale

The Agitated Behavior Scale (ABS; Corrigan, 1989) is a 14-item scale developed to monitor agitation during the acute phase of recovery from acquired brain injury. While previous studies have supported the reliability, internal consistency, and concurrent validity of the ABS, the current study was designed to investigate its underlying factor structure, as well as to determine systematic effects of time-of-day on the occurrence of agitation. Subjects were 212 patients with traumatic or other recently acquired brain injury who exhibited agitation during their treatment on a specialized brain-injury unit of an acute rehabilitation hospital. Confirmatory factor analysis revealed that agitation is best represented by one general construct with three underlying factors: Aggression, Disinhibition, and Lability. Analysis of agitation by nursing shift in which ratings were made confirmed that overall level was lowest during the night shift; however, the relationship between time-of-day and underlying factors deviated from this pattern. Results are discussed in terms of the necessity for objective measurement, definition of the construct of agitation, and time-of-day issues in sampling agitated behavior.

Required relaxation: A method of inhibiting agitative-disruptive behavior of retardates

Institutionalized retardates frequently exhibit agitative-disruptive behavior. Recent experiments have shown that overcorrective training in specific types of behavior can inhibit inappropriate behavior. A procedure was developed in which overcorrective practice in relaxation was given to each of eight adult retardates for their disruptions. The agitated resident was required to spend a fixed period of time in relaxation in his own bed upon each occurrence of agitation. This overcorrective relaxation resulted in a rapid, enduring and almost complete reduction in such behavior as self-injury, threats, physical aggression, screaming, crying, cursing and tantrums. Ward attendants strongly preferred the required relaxation procedure to the time-out technique and other inhibition procedures they had used. The procedure appears to be about as effective as alternative techniques and to have the advantages of ease of implementation and acceptability by ward staff and retardates as a ‘reasonable’ reaction to agitation.