Marco Catherine A, Vaughan Jason
Department of Emergency Medicine, St Vincent Mercy Medical Center, Toledo, OH 43608-2691, USA.
Am J Emerg Med. 2005 Oct;23(6):767-76. doi: 10.1016/j.ajem.2005.02.050.
Schizophrenia is a common psychiatric condition, affecting approximately 1% of the population. Acute emergent presentations often include hallucinations, delusions, thought, and speech disorders. Agitation is common among emergency patients with schizophrenia. Decisional capacity should be assessed in all patients. Reversible causes of agitation should be ruled out, including infection, metabolic disorders, endocrine disorders, trauma, pain, noncompliance, toxicological disorders, and structural brain abnormalities. Agitation may be managed acutely using a combination of pharmacological agents and nonpharmacological interventions. Effective pharmacological agents include several classes of antipsychotic agents and benzodiazepines. Potential life-threatening complications of pharmacological therapy should be anticipated, which may include neuroleptic malignant syndrome (NMS), prolonged QT syndrome, and respiratory depression. Nonpharmacological interventions may include a quiet environment, physical restraints, and behavioral interventions. Disposition decisions should be made based on the etiology of agitation, effective management, decisional capacity, and presence of suicidal or homicidal intentions. Many patients who have required nonpharmacological or pharmacological management of agitation require inpatient psychiatric treatment, either voluntarily or involuntarily. Psychiatric consultation should be sought for patients with schizophrenia and uncertain disposition determinations, or those requiring other complex management decisions.
精神分裂症是一种常见的精神疾病，影响着约1%的人口。急性紧急表现通常包括幻觉、妄想、思维和言语障碍。激越在精神分裂症急诊患者中很常见。应对所有患者进行决策能力评估。应排除激越的可逆性病因，包括感染、代谢紊乱、内分泌紊乱、创伤、疼痛、不依从、毒理学紊乱和脑结构异常。可通过联合使用药物和非药物干预措施对激越进行急性处理。有效的药物包括几类抗精神病药物和苯二氮䓬类药物。应预见到药物治疗可能出现的危及生命的并发症，其中可能包括抗精神病药恶性综合征（NMS）、QT间期延长综合征和呼吸抑制。非药物干预措施可能包括安静的环境、身体约束和行为干预。应根据激越的病因、有效管理、决策能力以及自杀或杀人意图的存在来做出处置决定。许多需要对激越进行非药物或药物管理的患者需要自愿或非自愿住院接受精神科治疗。对于精神分裂症患者且处置决定不确定或需要做出其他复杂管理决策的患者，应寻求精神科会诊。
