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Agitation

Restlessness

 

Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.

Considerations

 

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

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

Agitation with a change in alertness (altered consciousness) can be a sign of delirium . Delirium has a medical cause and should be checked by a health care provider right away.

 

Causes

 

There are many causes of agitation. Some of them are:

  • Alcohol intoxication or withdrawal
  • Allergic reaction
  • Caffeine intoxication
  • Certain forms of heart, lung, liver, or kidney disease
  • 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)
  • Overactive thyroid gland ( hyperthyroidism )
  • Infection (especially in elderly people)
  • Nicotine withdrawal
  • Poisoning (for example, carbon monoxide poisoning)
  • Some medicines, including theophylline, amphetamines, and steroids
  • Trauma
  • Vitamin B6 deficiency

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

  • Anxiety
  • Dementia (such as Alzheimer disease )
  • Depression
  • Mania
  • Schizophrenia

 

Home Care

 

The most important way to deal with agitation is to find and treat the cause. Agitation may lead to an increased risk of suicide and other forms of violence.

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

  • A calm environment
  • Enough lighting during the day and darkness at night
  • Medicines such as benzodiazepines, and in some cases, antipsychotics
  • Plenty of sleep

DO NOT physically hold back an agitated person, if possible. This usually makes the problem worse. Use restraints only if the person is at risk of harming themselves or others, and there is no other way to control the behavior.

 

When to Contact a Medical Professional

 

Contact your provider for agitation that:

  • Lasts a long time
  • Is very severe
  • Occurs with thoughts or actions of hurting yourself or others
  • Occurs with other, unexplained symptoms

 

What to Expect at Your Office Visit

 

Your provider will take a medical history and do a physical examination. To better understand your agitation, your provider may ask you specific things about your agitation.

Tests may include:

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

 

 

Open References

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders . 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

Bope ET, Kellerman RD. Psychiatric disorders. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2016 . Philadelphia, PA: Elsevier; 2016:section 15.

Inouye SK. Delirium or acute mental status change in the older patient. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 28.

Prager LM, Ivkovic A. Emergency psychiatry. In: Stern TA, Rosenbaum JF, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry . 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 88.

Young JL, Rund DA. Mood disorders. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 111.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

    Self Care

     
       

      Review Date: 2/21/2016

      Reviewed By: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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