Agitation (medical)

Agitation
Other names	Psychomotor agitation, restlessness
Specialty	Psychiatry, Neurology, Emergency medicine
Symptoms	Excessive motor activity, restlessness, pacing, hand-wringing, fidgeting, verbal outbursts
Complications	Injury, aggression, worsening of underlying condition
Usual onset	Variable
Duration	Variable, often acute
Causes	Psychiatric conditions (e.g. schizophrenia, bipolar disorder), delirium, substance use, withdrawal, medication side effects
Risk factors	Underlying psychiatric or neurological disorders, drug or alcohol use
Differential diagnosis	Anxiety, akathisia, delirium, psychosis
Prevention	Management of underlying conditions, medication adherence, early recognition
Treatment	Sedation, antipsychotics, benzodiazepines, behavioral interventions
Prognosis	Depends on cause and treatment
Frequency	Common in psychiatric and emergency settings

Agitation is a state of heightened motor and cognitive activity characterized by excessive or inappropriate verbal and physical behaviors, emotional excitement, and restlessness, often arising as a symptom of underlying medical, psychiatric, or neurological conditions. ^{[1] [2] [3]} It is considered both a medical and psychiatric emergency due to the potential for harm to patients, caregivers, and healthcare providers, and may escalate to aggression or violence if not promptly recognized and managed. ^{[1] [4] [5]}

Causes

The etiology of agitation is multifactorial, encompassing acute medical illnesses (such as infections, metabolic disturbances, or pain), substance intoxication or withdrawal, delirium, and a spectrum of psychiatric disorders including mood, psychotic, and personality disorders. ^{[2] [4] [6]}

Diagnosis

Early identification and a systematic evaluation to determine underlying causes are critical, as agitation of unknown origin should be presumed to have a medical cause until proven otherwise, particularly in populations such as the elderly or those without a prior psychiatric history. ^{[1] [3]}

Management

Effective management relies on a combination of non-pharmacological de-escalation strategies and, when necessary, targeted pharmacological interventions, always prioritizing the safety of all involved. ^{[2] [5]}

References

1. Curry A, Malas N, Mroczkowski M, Hong V, Nordstrom K, Terrell C (January 2023). "Updates in the Assessment and Management of Agitation". Focus (American Psychiatric Publishing). 21 (1): 35–45. doi:10.1176/appi.focus.20220064. PMC   10172538 . PMID   37205032.
2. Raveesh BN, Munoli RN, Gowda GS (March 2022). "Assessment and Management of Agitation in Consultation-Liaison Psychiatry". Indian Journal of Psychiatry. 64 (Suppl 2): S484 –S498. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_22_22 . PMC   9122159 . PMID   35602364.
3. Carrarini C, Russo M, Dono F, Barbone F, Rispoli MG, Ferri L, Di Pietro M, Digiovanni A, Ajdinaj P, Speranza R, Granzotto A, Frazzini V, Thomas A, Pilotto A, Padovani A, Onofrj M, Sensi SL, Bonanni L (2021). "Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions". Frontiers in Neurology. 12: 644317. doi: 10.3389/fneur.2021.644317 . PMC   8085397 . PMID   33935943.
4. Voineskos G (July 2018). "Book Review: The Diagnosis and Management of Agitation". Can J Psychiatry. 63 (7): 501. doi:10.1177/0706743718777395. PMC   6099773 .
5. Wilson MP, Pepper D, Currier GW, Holloman GH, Feifel D (February 2012). "The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup". The Western Journal of Emergency Medicine. 13 (1): 26–34. doi:10.5811/westjem.2011.9.6866. PMC   3298219 . PMID   22461918.
6. Zeller SL, Nordstrom KD, Wilson MP, eds. (2017). The Diagnosis and Management of Agitation. Cambridge University Press. doi:10.1017/9781316556702. ISBN   9781316556702.