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[6].[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
- ^ a b c 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.
- ^ a b c 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.
- ^ a b 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.
- ^ a b Voineskos G (July 2018). "Book Review: The Diagnosis and Management of Agitation". Can J Psychiatry. 63 (7): 501. doi:10.1177/0706743718777395. PMC 6099773.
- ^ a b 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.
- ^ Zeller SL, Nordstrom KD, Wilson MP, eds. (2017). The Diagnosis and Management of Agitation. Cambridge University Press. doi:10.1017/9781316556702. ISBN 9781316556702.