Passamar M, Tellier O, Vilamot B
SAUS, centre hospitalier Pierre-Jamet, Albi, France.
Encephale. 2011 Dec;37(6):448-56. doi: 10.1016/j.encep.2011.10.001. Epub 2011 Nov 4.
Psychomotor agitation, very common among psychiatric emergencies, raises the question of pharmaceutical sedation, its indications, and its issues, notably with regard to the observance in postemergency. A new approach to sedation places it within its therapeutic aim and also takes into account the sometimes harmful impact on the course of the patient's care. A pretherapeutical, analysis both clinical and environmental is crucial. The time spent on the initial meeting and assessment is essential. The evolution of professional practices in mental health allows us to distinguish three kinds of sedation (vigilance, behaviour and psychical) that guide the choice and the mode of psychotropic drug use. The harmful effects of an ever-increasing use of sedation is debated. The use of atypical antipsychotics and injectable forms is argued. Early psychical sedation is preferable to the obsolete practice of vigilance sedation and to behavioural sedation with its limited indications. The use of excessive or prolonged sedation might have a detrimental effect on the care offered after psychiatric emergency treatment.
精神运动性激越在精神科急诊中非常常见,这引发了药物镇静的问题,包括其适应症、相关问题,尤其是在急诊后观察方面。一种新的镇静方法将其置于治疗目标之内,同时也考虑到其有时对患者治疗过程产生的有害影响。治疗前进行临床和环境分析至关重要。花在初次会面和评估上的时间必不可少。心理健康领域专业实践的发展使我们能够区分三种镇静方式(警觉、行为和心理),这些方式指导着精神药物的选择和使用方式。镇静使用日益增加所产生的有害影响存在争议。有人主张使用非典型抗精神病药物和注射剂型。早期心理镇静优于过时的警觉镇静做法以及适应症有限的行为镇静。过度或长期使用镇静可能会对精神科急诊治疗后的护理产生不利影响。