Jacobs Journal of Internal Medicine

The Urgent and Unmet Need for Safe and Effective Treatment of Agitation

*Jo Ann LeQuang
Department Of Medicine, NEMA Research Inc., Naples, United States

*Corresponding Author:
Jo Ann LeQuang
Department Of Medicine, NEMA Research Inc., Naples, United States
Email:joann@leqmedical.com

Published on: 2018-08-23

Abstract

Agitation may occur in many settings: upon emergence from anesthesia, in the context of certain mental illnesses, secondary to brain injury or substance abuse, as a side effect of medication, and with certain forms of cognitive impairment. Agitation occurs frequently in patients with dementia, including but not limited to Alzheimer’s disease. This neuropsychiatric symptom is likely related to dysfunctional neurotransmissions, but the exact mechanisms remain unknown. There is no FDA-approved treatment for agitation but several agents are used off-label to help manage agitation, which can be a chronic and troublesome condition in patients with dementia. Antipsychotics, antidepressants, opioid analgesia, cannabinoids, antiepileptic agents, dextromethorphan, scyllo-inositol, brexipiprazole, and prazosin are discussed as possible treatments in the literature. The effectiveness of many pharmacological interventions for agitation can be equivocal and safety issues are of concern. Nonpharmacological interventions, such as music therapy, aromatherapy, and animal-assisted therapy, have reported modest success but may be difficult to implement emergency departments as well as in some institutionalized settings. As the geriatric population in developed nations increases, agitation secondary to various forms of dementia will likely increase as well. Agitation can pose risks to patients and their caregivers and there is an urgent unmet medical need to find safe, effective treatments.

Keywords

Introduction

Neuropsychiatric symptoms remain challenging to treat. These behavioral symptoms can be distressing to patients, extraordinarily burdensome to caregivers, and costly to the healthcare system as extensive neuropsychiatric symptomology is associated with increased risk of institutionalization [1]. Agitation, a neuropsychiatric symptom, may occur in the context of apathy, depression, anxiety, and restlessness [2]. As early as 1989 agitation was defined as “inappropriate verbal, vocal, or motor activity that is not explained by needs or confusion, per se.”[3] Agitation is associated with excessive psychomotor activity, emotional distress, aggressive behaviors, disruptive irritability, and disinhibition [4]. Agitated individuals may wander, cry out, complain, use foul language, display aggressive behaviors or repetitive movements, and be uncooperative, negative, and disruptive [3]. Agitation increases the patient’s risk of injury and reduces his or her quality of life [1].