Agitation
Restlessness
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
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 them are:
- 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 opiods)
- Hospitalization (older adults often have delirium while in the hospital)
- Overactive thyroid gland (hyperthyroidism)
- Infection (especially in elderly people)
- Nicotine withdrawal
- Poisoning (for example, carbon monoxide poisoning)
- Some medicines, including theophylline, amphetamines, and steroids
- Trauma
- Vitamin B6 deficiency
Agitation can occur with brain and mental health disorders, such as:
- Anxiety
- Dementia (such as Alzheimer disease)
- Depression
- Mania
- Schizophrenia
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
- Medicines 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. Use restraints only 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 provider for agitation that:
- Lasts a long time
- Is very severe
- Occurs with thoughts or actions of hurting yourself or others
- Occurs with other, unexplained symptoms
If you are thinking about hurting yourself or others, call or text 988 or chat
You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.
If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.
What to Expect at Your Office Visit
Your provider will take a medical history and do a physical examination. To better understand your agitation, your provider may ask you specific things about your agitation.
Tests may include:
- Blood tests (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)
Treatment depends on the cause of your agitation.
References
American Psychiatric Association website. Schizophrenia spectrum and other psychotic disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:87-122.
Inouye SK. Delirium in the older patient. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 25.
Prager LM, Ivkovic A. Emergency psychiatry. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 88.
Version Info
Last reviewed on: 4/30/2022
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
