Agitation

Agitation

Definition:

A unpleasant state of extreme arousal, increased tension, and irritability. See also anxiety, stress, and tension.

Alternative Names:

Restlessness

Considerations:

Extreme agitation can lead to confusion, hyperactivity, and outright hostility. Agitation can come on suddenly or gradually. It can last for just a few minutes or for weeks and even months. External stimuli, pain, stress, and fever all increase agitation.

Agitation by itself may not have much clinical significance; but, if viewed with other symptoms, it can be a good indicator of a disease state.

Common Causes:

anxiety
alcohol withdrawal
appetite suppressants (such as amphetamines)
caffeine
cocaine intoxication
nicotine withdrawal
drug withdrawal (see cocaine withdrawal and opiate withdrawal)
Vitamin B6 deficiency
hyperthyroidism
drugs such as amphetamines, cocaine, ephedrine, or theophylline
certain medical tests that involve injecting a "contrast medium" into the patient
hallucinogenic drugs

Home Care:

A calm environment, plenty of sleep, adequate lighting, and any measure to reduce stress may help to decrease agitation. Avoid restraining an overly-agitated person if possible, since this usually makes the problem worse.

Communication of feelings is important.

Call your health care provider if:

there is prolonged or severe agitation, especially if accompanied by other unexplained symptoms.

What to expect at your health care provider's office:

Your health care provider will obtain a medical history from either the patient or a family member and do a physical examination.

Medical history questions documenting agitation in detail may include:

type
- Is the patient more talkative than usual or is there a feeling of pressure to keep talking?
- Does the patient show increased purposeless activity (e.g., pacing, hand wringing)?
- Is the patient extremely restless?
- Is the patient trembling or twitching?
time pattern
- Was the agitation a short episode?
- Is the agitation persistent?
  - How long did it persist -- 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?
- Does the patient take any medications, in particular, steroids or thyroid medicine?
- How much alcohol does the patient drink?
- How much caffeine does the patient drink?
- Does the patient use any drugs, in particular, cocaine, narcotics, or amphetamines (speed)?
other
- What other symptoms are also present?
- Is there confusion, memory loss, hyperactivity, or hostility (these symptoms may play an important role in diagnosis).

Diagnostic tests may include:

vital signs (temperature, pulse, rate of breathing, blood pressure)
blood studies (such as CBC, blood differential, thyroid studies, drug screening)
head CT scan or cranial MRI (head)
lumbar puncture
X-rays of the skull

After seeing your health care provider:
You may want to add a diagnosis related to agitation to your personal medical record.

Review Date: 11/20/2001
Reviewed By: Donna R. Cooper, M.D., M.P.H., Department of Medicine, Massachusetts General Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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