Objective:To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil.Methods:This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools.Results:Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration.Conclusion:If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation.Systematic review registry number:CRD42017054440.

Objective:To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil.Methods:These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools.Results:We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient’s appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree.Conclusion:The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint.Systematic review registry number:CRD42017054440.

Objective: To present the Brazilian Psychiatric Association's Consensus for the Management of Acute Intoxication.Methods: A group of experts selected by the Brazilian Psychiatric Association searched for articles in the MEDLINE (by PubMed) and Cochrane Database, limited to human studies and acute intoxication. Groups reviewed these materials for appropriateness to the topic and the quality of the work. To perform a table of agreed recommendations at the end of the systematic review, a survey using the Delphi method was conducted. Three survey rounds were conducted to develop a consensus. Results: Support for intoxication may start with Initial Management: Resuscitation/Life Support/Differential Diagnosis. For that, the group proposed these orders of assessment: A (airway), B (breathing), C (circulation), D.1. (disability), D.2. (differential diagnos is), D.3. (decontamination), D.4. (drug antidotes), E (enhanced elimination). Then, the group of experts presented specific interventions for the main drugs of abuse.

The aims of the present study were to provide an in-depth comparison of inter-limb asymmetry and determine how consistently asymmetry favours the same limb during different vertical jump tests. Eighteen elite female under-17 soccer players conducted unilateral squat jumps (SJ), countermovement jumps (CMJ) and drop jumps (DJ) on a portable force platform, with jump height, peak force, concentric impulse and peak power as common metrics across tests.For the magnitude of asymmetry, concentric impulse was significantly greater during the SJ test compared to CMJ (p = 0.019) and DJ (p = 0.003). No other significant differences in magnitude were present. For the direction of asymmetry, Kappa coefficients revealed fair to substantial levels of agreement between the SJ and CMJ (Kappa = 0.35 to 0.61) tests, but only slight to fair levels of agreement between the SJ and DJ (Kappa = -0.26 to 0.18) and CMJ and DJ (Kappa = -0.13 to 0.26) tests. These results highlight that the mean asymmetry value may be a poor indicator of true variability of between-limb differences in healthy athletes. The direction of asymmetry may provide a useful monitoring tool for practitioners in healthy athletes, when no obvious between-limb deficit exists.

OBJECTIVE:Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the behavioral activity rating scale (BARS) into Brazilian Portuguese and assess the psychometric properties of the scale. METHODS:An expert committee consensus conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians applied the BARS-BR and the Sedation-Agitation Scale (SAS) to patients admitted in the psychiatry emergency room and patients in the psychiatric hospital wards. BARS-BR was compared to SAS, in order to assess the concurrent validity, and internal consistency was evaluated with the Bland-Altman technic. RESULTS:In the emergency room, the correlation coefficients between the first and second assessments were r = 0.997 and r = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was r = 0.951. There was a strong correlation between the BARS-BR score of the first examiner and the SAS score of the second examiner (r = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (r = 0.893). CONCLUSION:The BARS-BR showed good psychometric properties, and we suggest its use because it is easy to assess changes in psychomotor activity. Further studies are suggested to evaluate the adoption and comprehension of the BARS-BR scale by all healthcare professionals.

The prevalence of mental health problems in the general population during a public calamity is high. In calamities, the number of patients who present with mental disorder outbreaks or crises may increase, but the necessary support systems to help them may be impaired if they have not been planned for. Although there are several models for addressing psychiatric emergencies, the general rules are the same, especially when it comes to making these services easily available to the affected population. In this article, we seek to review and present recommendations for the management of psychiatric emergencies in situations of public calamity, including disasters, physical and medical catastrophes, epidemics, and pandemics.

Neste primeiro artigo, apresentamos os aspectos gerais dessa diretriz. Na sequência, apresentamos os cuidados gerais do ambiente e equipe e, posteriormente, a avaliação de pacientes agitados, principalmente focada no diagnóstico diferencial. Número de registro da revisão sistemática: CRD42017054440.

Neste último artigo, faremos a comparação entre os diferentes grupos medicamentosos. Posteriormente, apresentaremos as possíveis combinações de medicações para a tranquilização rápida. Por fim, abordaremos o manejo de grupos especiais em agitação psicomotora.