Agitation

Agitation is a state of heightened arousal characterized by increased motor activity, restlessness, irritability, and emotional distress. It is a symptom rather than a specific diagnosis and can occur in many medical, neurological, and psychiatric conditions. The onset may be acute or gradual, and it can range from mild fidgeting to severe psychomotor agitation with aggression or delirium.

Common causes include primary psychiatric disorders such as mania, acute psychosis, anxiety disorders, and obsessive-compulsive spectrum disorders; delirium due to medical illness, infection, or metabolic derangements; and neurodegenerative diseases with behavioral disturbance. Substance use or withdrawal (for example, stimulants, alcohol, or benzodiazepines), pain, sleep deprivation, and environmental stressors may also produce agitation. Medications with anticholinergic, sympathomimetic, or serotonergic effects can contribute as well.

Clinical presentation varies but often includes restlessness, pacing or repetitive movements, rapid or loud speech, irritability, and difficulty concentrating. Vital signs may be abnormal (tachycardia, hypertension), and there may be tremor, diaphoresis, or features of delirium or psychosis. Differentiating agitation from anxiety or normal stress requires a thorough history, examination, and assessment of cognitive function, attention, and awareness.

Assessment focuses on identifying the underlying cause, safety risks, and severity. Tools such as the Cohen-Maman-Mansfield agitation inventory are used in specific settings. Management emphasizes safety, de-escalation, and treatment of the underlying cause. Nonpharmacologic approaches include a calm environment, reassurance, and minimizing stimuli. When needed, pharmacologic options such as antipsychotics or benzodiazepines are used with consideration of the clinical context and potential risks, especially in delirium or cognitive impairment.