Anxiety, Distress and Agitation
- Attempt to identify and reverse causes.
- Exclude acute delirium and treat if required as per Delirium Section.
- Manage any symptoms of acute anxiety.
- Spiritual, social and religious issues require a multi-disciplinary approach.
- Precipitants such as fear (requiring explanation and reassurance or the presence of a relative) or unrelieved physical symptoms must be addressed, e.g. constipation, urinary retention, and alcohol or nicotine withdrawal.
- An antidepressant may need to be considered.
Pharmacological treatment is aimed at relieving symptoms of anxiety, usually with benzodiazepines. The drugs and doses below are not used for sedation. Sedation may occasionally be indicated in the terminally ill when agitation or extreme fear is unrelieved - a referral to the Palliative Care Service is strongly recommended (see Terminal Agitation).
- Clonazepam 0.25 – 1 mg nocte – tabs or oral drops 0.1 mg/drop (1-5 drops q6h prn).
- Lorazepam 0.5 - 2 mg PO/SL, 4 - 6 hourly.
- Midazolam nasal spray.
- Diazepam 2 - 10 mg PO or PR, 8 - 12 hourly.
Caution: Clonazepam has a long half-life and can accumulate in repeated dosing.
Topic Code: 4139