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Central nervous system

Agitation

Definition

Agitation is an unpleasant state of extreme arousal, increased tension, and irritability.

Alternative Names

Restlessness

Considerations

Extreme agitation can lead to:

• Confusion
• Hostility
• Hyperactivity

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 changed awareness (altered consciousness), doctors often call this "delirium." Usually this has a medical cause such as alcohol withdrawal or an infection (in elderly adults). Older adults often have delirium while hospitalized.

Causes

Causes of agitation include:

• Alcohol withdrawal
• Caffeine
• Cocaine, hallucinogenic drugs, ephedrine
• Cocaine withdrawal
• Hyperthyroidism
• Medical tests that involve injecting a "contrast medium" into the patient
• Nicotine withdrawal
• Opiate withdrawal
• Theophylline or other medicines
• Vitamin B6 deficiency

Agitation can be associated with:

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

Home Care

The following can reduce agitation:

• A calm environment
• Adequate lighting
• Plenty of sleep
• Stress-reducing measures

Don't restrain an overly-agitated person if possible. This usually worsens the problem.

Communicating your feelings is important.

When to Contact a Medical Professional

Contact your health care provider if you have prolonged or severe agitation, especially if you also have other unexplained symptoms.

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 CBC, blood differential, thyroid studies, drug screening)
• Head CT scan or cranial MRI (head)
• Lumbar puncture or spinal tap
• Vital signs (temperature, pulse, breathing rate, blood pressure)
• X-rays of the skull

Moore DP, Jefferson JW. Moore & Jefferson: Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby; 2004:chap 155.

See also: Drugs associated with Agitated State

Review Date: 5/26/2008
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Timothy A. Rogge, MD, private practice in Psychiatry, Kirkland, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.