Psychomotor agitation and aggressive behavior in the pediatric emergency department
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Copyright (c) 2023 Revista de Psiquiatría Infanto-Juvenil
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https://doi.org/10.31766/revpsij.v40n1a2Keywords:
aggression, child, emergency service, adolescentsAbstract
Introduction: In recent years, the number of emergencies related to child mental health problems has increased significantly. Our aim is to describe the children with aggressive behavior attended in our emergency department and to analyze possible risk factors related to the most severe episodes. Materials and methods: Retrospective study conducted between January 2011-December 2020 at La Paz Children Hospital. Children under 16 years diagnosed with aggressive behavior were included, excluding self-harm. Episodes that required pharmacological or physical restraint were classified as severe. Results: A total of 114 episodes were recorded (78.1% male; median age 13.2 years). Psychiatric history was present in 93.8%, 18.4% with attention deficit hyperactivity disorder. Episode duration was less than 24 hours in 81.6%. Aggression was mainly directed against third parties (69.3%). Among the triggers, the presence of domestic conflicts accounted for 46.5% of the cases, 18.8% of which were related to the use of cell phones. Thirty-five episodes (30.7%) were considered severe. None of the variables analyzed showed statistically significant association with severity. Conservative measures were used to manage the episode in 74.6% of the cases, pharmacological containment in 27.7% and physical restraints in 6.1%. Conclusion: Emergencies due to aggressive behavior were more frequent in boys and patients with history of psychological or psychiatric disorders. In most cases, they were solved with conservative measures. Cases requiring pharmacological treatment and/or physical restraint were not associated with any risk factor that could predict the severity of the violent behavior.
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Fernández-Quintana Á, Novo-Ponte A, Quiroga-Fernández C, Méndez-Iglesias R, Pereiro-Gómez C. Urgencias psiquiátricas infanto-juveniles: 7 años de seguimiento. Rev Psiquiatr Infanto-Juv. 2018;17–30. https://doi.org/10.31766/revpsij.v35n1a2 DOI: https://doi.org/10.31766/revpsij.v35n1a2
Gottlieb M, Long B, Koyfman A. Approach to the Agitated Emergency Department Patient. The Journal of Emergency Medicine. 2018 Apr;54(4):447–57. https://doi.org/10.1016/j.jemermed.2017.12.049 DOI: https://doi.org/10.1016/j.jemermed.2017.12.049
Day RK. Psychomotor agitation: poorly defined and badly measured. Journal of Affective Disorders. 1999 Oct;55(2–3):89–98. https://doi.org/10.1016/S0165-0327(99)00010-5 DOI: https://doi.org/10.1016/S0165-0327(99)00010-5
Jiménez Busselo MT, Aragó Domingo J, Nuño Ballesteros A, Loño Capote J, Ochando Perales G. Atención al paciente agitado, violento o psicótico en urgencias: un protocolo pendiente para una patología en aumento. Anales de Pediatría. 2005 Dec;63(6):526–36. https://doi.org/10.1016/S1695-4033(05)70253-8 DOI: https://doi.org/10.1016/S1695-4033(05)70253-8
Álvarez-Hernández M, Castro-Pañeda P, González-González-de-Mesa C, Álvarez-Martino E, Campo-Mon MÁ. Conductas disruptivas desde la óptica del docente: validación de una escala. AN PSICOL-SPAIN. 2016 Jul 28;32(3):855. https://doi.org/10.6018/analesps.32.3.223251 DOI: https://doi.org/10.6018/analesps.32.3.223251
Maccoby EE, Jacklin CN. Sex differences in aggression: a rejoinder and reprise. Child Dev. 1980 Dec;51(4):964–80. DOI: https://doi.org/10.2307/1129535
Novaes CM, Pondé MP, Freire ACC. Control of psychomotor agitation and aggressive behavior in patients with autistic disorder: a retrospective chart review. Arq Neuro-Psiquiatr. 2008;66(3b):646–51. https://doi.org/10.1590/S0004-282X2008000500008 DOI: https://doi.org/10.1590/S0004-282X2008000500008
Rocker JA, Oestreicher J. Focused Medical Assessment of Pediatric Behavioral Emergencies. Child and Adolescent Psychiatric Clinics of North America. 2018 Jul;27(3):399–411. https://doi.org/10.1016/j.chc.2018.02.003 DOI: https://doi.org/10.1016/j.chc.2018.02.003
Porter M, Gracia R, Oliva JC, Pàmias M, Garcia-Parés G, Cobo J. Mental Health Emergencies in Paediatric Services: Characteristics, Diagnostic Stability and Gender differences. Actas Esp Psiquiatr. 2016 Nov;44(6):203–11.
Yip L, Aeng E, Elbe D. Management of Acute Agitation and Aggression in Children and Adolescents with Pro Re Nata Oral Immediate Release Antipsychotics in the Pediatric Emergency Department. Journal of Child and Adolescent Psychopharmacology. 2020 Nov 1;30(9):534–41. https://doi.org/10.1089/cap.2019.0171 DOI: https://doi.org/10.1089/cap.2019.0171
Baldaçara L, Diaz AP, Leite V, Pereira LA, dos Santos RM, Gomes Júnior V de P, et al. Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach. Braz J Psychiatry. 2019 Aug;41(4):324–35. https://doi.org/10.1590/1516-4446-2018-0177 DOI: https://doi.org/10.1590/1516-4446-2018-0177
Laita de Roda P, Menéndez Suso JJ. Agitación psicomotriz. In: Decisiones en urgencias pediátricas. 2a. Elsevier; p. 1162–9.
Mahajan P, Alpern ER, Grupp-Phelan J, Chamberlain J, Dong L, Holubkov R, et al. Epidemiology of Psychiatric-Related Visits to Emergency Departments in a Multicenter Collaborative Research Pediatric Network: Pediatric Emergency Care. 2009 Nov;25(11):715–20. https://doi.org/10.1097/PEC.0b013e3181bec82f DOI: https://doi.org/10.1097/PEC.0b013e3181bec82f
Scivoletto S, Boarati MA, Turkiewicz G. Emergências psiquiátricas na infância e adolescência. Rev Bras Psiquiatr. 2010 Oct;32(suppl 2):S112–20. https://doi.org/10.1590/S1516-44462010000600008 DOI: https://doi.org/10.1590/S1516-44462010000600008
Ziaei M, Massoudifar A, Rajabpour-Sanati A, Pourbagher-Shahri AM, Abdolrazaghnejad A. Management of Violence and Aggression in Emergency Environment; a Narrative Review of 200 Related Articles. Advanced Journal of Emergency Medicine [Internet]. 2018 Nov 29 [citado el 9 de octubre de 2022 ];(In press). https://doi.org/10.22114/ajem.v0i0.117
Villacrés Betancourt RH. Criminalidad y disfunción familiar en adolescentes infractores. 2011 [citado el 29 de diciembre de 2022]; Disponible en: http://www.dspace.uce.edu.ec/handle/25000/1625
Billieux J. Problematic Use of the Mobile Phone: A Literature Review and a Pathways Model. CPSR. 2012 Oct 1;8(4):299–307. https://doi.org/10.2174/157340012803520522 DOI: https://doi.org/10.2174/157340012803520522
Vandrey R, Budney AJ, Kamon JL, Stanger C. Cannabis withdrawal in adolescent treatment seekers. Drug and Alcohol Dependence. 2005 May;78(2):205–10. https://doi.org/10.1016/j.drugalcdep.2004.11.001 DOI: https://doi.org/10.1016/j.drugalcdep.2004.11.001
Barthelemy OJ, Richardson MA, Cabral HJ, Frank DA. Prenatal, perinatal, and adolescent exposure to marijuana: Relationships with aggressive behavior. Neurotoxicology and Teratology. 2016 Nov;58:60–77. https://doi.org/10.1016/j.ntt.2016.06.009 DOI: https://doi.org/10.1016/j.ntt.2016.06.009
Observatorio Español de las Drogas y las Adicciones. Informe 2021. Alcohol, tabaco y drogas ilegales en España. Madrid: Ministerio de Sanidad. Delegación del Gobierno para el Plan Nacional sobre Drogas; 2021. [citado el 22 de noviembre de 2022]; Disponible en: https://pnsd.sanidad.gob.es/profesionales/sistemasInformacion/informesEstadisticas/pdf/2021OEDA-INFORME.pdf
Ávila AB, D’Andrea G, Alonso MM, Gallegos MG, Delgadillo LM, Orozco C. Crianza parental asociada al consumo de drogas y alteraciones en salud mental en adolescentes infractores. 2018;7.
Peñafiel Pedrosa EM. Factores de riesgo y protección en el consumo de sustancias en adolescentes. Pulso: revista de educación. 2009;(32):147–73. DOI: https://doi.org/10.58265/pulso.4994
Dorfman DH, Mehta SD. Restraint Use for Psychiatric Patients in the Pediatric Emergency Department: Pediatric Emergency Care. 2006 Jan;22(1):7–12. https://doi.org/10.1097/01.pec.0000195758.12447.69 DOI: https://doi.org/10.1097/01.pec.0000195758.12447.69
Sheridan DC, Spiro DM, Fu R, Johnson KP, Sheridan JS, Oue AA, et al. Mental Health Utilization in a Pediatric Emergency Department: Pediatric Emergency Care. 2015 Aug;31(8):555–9. https://doi.org/10.1097/PEC.0000000000000343 DOI: https://doi.org/10.1097/PEC.0000000000000343
Jenkins M, Barrett MC, Frey T, Bouvay K, Barzman D, Kurowski EM. Adherence with an Acute Agitation Algorithm and Subsequent Restraint Use. Psychiatr Q. 2021 Sep;92(3):851–62. https://doi.org/10.1007/s11126-020-09860-0 DOI: https://doi.org/10.1007/s11126-020-09860-0
Gerson R, Malas N, Mroczkowski MM. Crisis in the Emergency Department. Child and Adolescent Psychiatric Clinics of North America. 2018 Jul;27(3):367–86. https://doi.org/10.1016/j.chc.2018.02.002 DOI: https://doi.org/10.1016/j.chc.2018.02.002
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