Dexmedetomidina como um Tratamento Emergente de Agitação em Doentes Psiquiátricos: Uma Revisão Narrativa

Autores

  • Sabrina Magueta Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal https://orcid.org/0000-0002-6020-3024
  • Ana Costa Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal https://orcid.org/0000-0001-8227-0124
  • Gisela Simões Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • João Alcafache Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal https://orcid.org/0000-0002-7755-6774
  • Paula Garrido Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal

DOI:

https://doi.org/10.51338/rppsm.506

Palavras-chave:

Agitação Psicomotora/tratamento farmacológico, Dexmedetomidina/uso terapêutico

Resumo

A agitação psicomotora aguda ocorre numa variedade de condições médicas e psiquiátricas sendo a forma de apresentação clínica numa percentagem significativa de episódios psiquiátricos urgentes, requerendo intervenção rápida e eficaz. Tradicionalmente, a agitação psicomotora era gerida nas enfermarias psiquiátricas com recurso à contenção física. Com o aparecimento dos neurolépticos tranquilizantes, tais como a cloropromazina, o manejo farmacológico destes estados passou a ser possível. A agitação psicmotora embora seja um resultado potencial da maioria das perturbações psiquiátricas, está frequentemente associada a quadros psicóticos, perturbações do humor e perturbações neurodegenerativas. No presente artigo, os autores propõem explorar a dexmedetomidina como opção terapêutica em estados de agitação psicomotora aguda em quadros psiquiátricos nos quais os fármacos tradicionais não surtiram efeito. Para o efeito, foi realizada uma revisão não-sistemática da literatura. As palavras-chave utilizadas incluíram: dexmedetomidine, acute agitation, rapid tranquilisation, restraint, sedation, psychiatric population, psychiatric disorders. Recentemente, um passo significativo nos métodos de tratamento da agitação psicomotora aguda foi alcançado através da utilização da dexmedetomidina em quadros psiquiátricos. A dexmedetomidina trata-se de um agonista seletivo do receptor‐α2 tendo aprovação para sedação a curto prazo com o benefício de não provocar sedação excessiva, permitindo desta forma uma abordagem psicoterapêutica concomitante. Este fármaco demonstra ser uma opção de tratamento promissora para doentes em estado de agitação psicomotora aguda. A quantidade de estudos disponíveis sobre a sua utilidade na doença mental são, contudo, escassas. As recomendações acerca da intervenção nos quadros de agitação no doente psiquiátrico presentes na literatura foram desenvolvidas com base em dados de investigação, considerações teóricas e experiência clínica, no entanto são necessários estudos que forneçam dados e recomendações definitivas. É imperativo que a investigação dos episódios de agitação psicomotora aguda e a sua contenção evolua, de forma proteger estes doentes das consequências do comportamento e, eventualmente, do tratamento. A exploração do potencial da dexmedetomidina como ferramenta disponível no arsenal terapêutico para o tratamento dos quadros de agitação em contexto de doença mental, ganha particular sentido face à ausência de alternativas que tranquilizem o doente muito agitado sem provocarem sedação excessiva.

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Publicado

2024-04-09

Como Citar

Magueta, S., Costa, A., Simões, G., Alcafache, J., & Garrido, P. (2024). Dexmedetomidina como um Tratamento Emergente de Agitação em Doentes Psiquiátricos: Uma Revisão Narrativa. Revista Portuguesa De Psiquiatria E Saúde Mental, 10(1), 21–29. https://doi.org/10.51338/rppsm.506

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Revisão Narrativa