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Agitation

Definition

Agitation is an unpleasant state of extreme arousal (stirred up or excited), increased tension, and irritability.

Alternative Names

Restlessness

Considerations

Agitation can come on suddenly or over time. It can last for just a few minutes, or for weeks and even months. Pain, stress, and fever can all increase agitation.

Agitation by itself may not be a sign of a health problem. However, if other symptoms occur, it can be a sign of disease.

When agitation lasts for hours and there is a change in alertness (altered consciousness), doctors call this delirium. Delerium always has a medical cause.

Common Causes

There are many causes of agitation, some of which include:

• Alcohol intoxication or withdrawal
• Caffeine intoxication
• Intoxication or withdrawal from drugs of abuse (such as cocaine, marijuana, hallucinogens, PCP, or opiates)
• Hospitalization (older adults often have delirium while in the hospital)
• Hyperthyroidism (overactive thyroid gland)
• Infection (more often in elderly people)
• Medical tests that involve injecting a "contrast medium" into the patient
• Nicotine withdrawal
• Theophylline or other medicines
• Vitamin B6 deficiency

Agitation can occur with brain and mental health disorders, such as:

• Anxiety
• Bipolar disorder
• Dementia (such as Alzheimer's disease)
• Depression
• Schizophrenia

Home Care

The most important way to deal with agitation is to find and treat the cause. If left untreated, agitation leads to an increased risk of suicide.

After treating the cause, the following measures can reduce agitation:

• A calm environment
• Adequate lighting
• Medications such as benzodiazepines, and in some cases, antipsychotics
• Plenty of sleep

Don't restrain an overly agitated person, if possible. This usually makes the problem worse. Only use restraints if the person is at risk of harming themselves or others, and there is no other, less restrictive way to control the behavior.

Call your health care provider if

Contact your health care provider for agitation:

• That lasts for a long period of time
• That is very severe
• If there are other unexplained symptoms

What to expect at your health care provider's office

Your health care provider will take a medical history and do a physical examination.

To help better understand your agitation, your doctor may ask the following questions:

• Type
  • Are you more talkative than usual or do you feel pressure to keep talking?
  • Do you find yourself doing purposeless activities (e.g., pacing, hand wringing)?
  • Are you extremely restless?
  • Are you trembling or twitching?
• Time pattern
  • Was the agitation a short episode?
  • Is the agitation persistent?
    • How long did it last -- for how many day(s)?
• Aggravating factors
  • Does the agitation seem to be triggered by reminders of a traumatic event?
  • Did you notice anything else that may have triggered agitation?
  • Do you take any medications, especially steroids or thyroid medicine?
  • How much alcohol do you drink?
  • How much caffeine do you drink?
  • Do you use any drugs, such as cocaine, narcotics, or "speed" (amphetamines)?
• Other
  • What other symptoms do you have?
  • Is there confusion, memory loss, hyperactivity, or hostility (these symptoms can play an important role in diagnosis).

Diagnostic tests may include:

• Blood studies (such as a blood count, infection screening, thyroid tests, or vitamin levels)
• Head CT or head MRI scan
• Lumbar puncture or spinal tap
• Urine tests (infection screening, drug screening)
• Vital signs (temperature, pulse, breathing rate, blood pressure)
• X-rays of the skull

References

Park JM, Park L, Prager LM. Emergency psychiatry. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 87.

Rossi J, Swan MC, Isaacs ED. The violent or agitated patient. Emerg Med Clin North Am. 2010;28:235-256.