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Agitation

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

Alternative Names

Restlessness

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 which include:

  • 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)
  • Hyperthyroidism (overactive thyroid gland)
  • Infection (especially in elderly people)
  • Nicotine withdrawal
  • Poisoning (for example, carbon monoxide poisoning)
  • Theophylline, amphetamines, steroids, and certain other medicines
  • Trauma
  • Vitamin B6 deficiency

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

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
  • Medications 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. Only use restraints 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 health care provider for agitation that:

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

What to Expect at Your Office Visit

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

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 (spinal tap)
  • Urine tests (for infection screening, drug screening)
  • Vital signs (temperature, pulse , breathing rate, blood pressure)

References

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

Inouye SK. Delirium or acute mental status change in the older patient. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 27.

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

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

Updated: 2/24/2014

Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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