Restlessness

Restlessness is a subjective sense of inner unease or agitation that drives the urge to move. It is often accompanied by observable behaviors such as pacing, fidgeting, shifting positions, or an inability to sit still. Restlessness can occur in a range of medical and psychiatric contexts and is a central feature of certain conditions, such as akathisia and restless legs syndrome.

Restlessness may appear suddenly or persist over time and can accompany or worsen other symptoms, including anxiety, irritability, sleep disturbance, or pain. It commonly arises in the setting of acute illness (fever, infection, metabolic disturbance), neurological or endocrine disorders, and as a side effect of medications such as antipsychotics, antidepressants, stimulants, or caffeine withdrawal. Psychiatric conditions like anxiety disorders, mood disorders, and delirium can also present with marked restlessness.

Evaluation involves a careful history and examination to establish onset, duration, triggers, and associated symptoms, along with a review of current medications and substance use. Physical and neurological exams help identify underlying causes. Laboratory tests may include complete blood count, thyroid function, iron studies, and markers of infection or metabolic disturbance as indicated. Differential diagnosis includes akathisia, agitation related to delirium or mania, restless legs syndrome, anxiety disorders, and other causes of heightened motor activity.

Management centers on treating the underlying cause. For akathisia, adjust the offending medication and consider agents such as beta-blockers or short-term benzodiazepines. For restless legs syndrome, assess and correct iron deficiency and use dopaminergic therapies as appropriate. For anxiety- or mood-related restlessness, psychotherapy and appropriate pharmacotherapy are used, supplemented by nonpharmacologic strategies such as sleep hygiene and stress management. Prognosis varies with the underlying condition; some forms are reversible, while others are chronic.