DefinitionAgitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
ConsiderationsAgitation can come on suddenly or over time. It can last for just a few minutes, or 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. However, 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.
Common CausesThere are many causes of agitation, some of which include:Alcohol intoxication or withdrawalAllergic reactionCaffeine intoxicationCertain forms of heart, lung, liver, or kidney diseaseIntoxication 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 withdrawalPoisoning (for example, carbon monoxide poisoning)Theophylline, amphetamines, steroids, and certain other medicinesTraumaVitamin B6 deficiencyAgitation can occur with brain and mental health disorders, such as:Anxiety
Dementia (such as Alzheimer's disease)DepressionManiaSchizophrenia
Home CareThe 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 environmentEnough lighting during the day and darkness at nightMedications such as benzodiazepines, and in some cases, antipsychoticsPlenty of sleepDon't 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.
Call your health care provider ifContact your health care provider for agitation that:Lasts a long timeIs very severeOccurs with thoughts or actions of hurting oneself or othersOccurs with other, unexplained symptoms
What to expect at your health care provider's officeYour health care provider will take a medical history and do a physical examination.To help better understand your agitation, your health care provider 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?Does the agitation last?
How long does it last -- for how many day(s)?Factors that make it worse
Does the agitation seem to be triggered by reminders of a traumatic event?Did you notice anything else that may have triggered the 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, opiates, or 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).Tests may include:Blood studies (such as a blood count, infection screening, thyroid tests, or vitamin levels)Head CT or head MRI scanLumbar puncture (spinal tap)Urine tests (for infection screening, drug screening)Vital signs (temperature, pulse, breathing rate, blood pressure)
ReferencesPark JM, Park L, Prager LM. Emergency psychiatry. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 87.Rossi J, Swan MC, Isaacs ED. The violent or agitated patient. Emerg Med Clin North Am. 2010;28:235-256.Inouye SK. Delirium or acute mental status change in the older patient. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 27.