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Agitation is an unpleasant state of extreme arousal, increased tension, and irritability.

Extreme agitation can lead to:

• Confusion
• Hostility
• Hyperactivity

Agitation can come on suddenly or over time. It can last for just a few minutes, or for weeks and 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.

When agitation lasts for hours and there is changed awareness (altered consciousness), doctors often call this "delirium." Usually this has a medical cause such as alcohol withdrawal or an infection (in elderly adults). Older adults often have delirium while hospitalized.

Causes of agitation include:

• Alcohol withdrawal
• Caffeine
• Cocaine, hallucinogenic drugs, ephedrine
• Cocaine withdrawal
• Hyperthyroidism
• Medical tests that involve injecting a "contrast medium" into the patient
• Nicotine withdrawal
• Opiate withdrawal
• Theophylline or other medicines
• Vitamin B6 deficiency

Agitation can be associated with:

• Anxiety
• Bipolar disorder
• Dementia (such as Alzheimer's disease)
• Depression
• Schizophrenia

The following can reduce agitation:

• A calm environment
• Adequate lighting
• Plenty of sleep
• Stress-reducing measures

Don't restrain an overly agitated person if possible. This usually worsens the problem.

Communicating your feelings is important.

Contact your health care provider if you have prolonged or severe agitation, especially if you also have other unexplained symptoms.

Your health care provider will take a medical history and do a physical examination.

To help better understand your agitation, your doctor 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?
  • Is the agitation persistent?
    • How long did it last -- 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?
  • 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, narcotics, or "speed" (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).

Diagnostic tests may include:

• Blood studies (such as CBC, blood differential, thyroid studies, drug screening)
• Head CT scan or cranial MRI (head)
• Lumbar puncture or spinal tap
• Vital signs (temperature, pulse, breathing rate, blood pressure)
• X-rays of the skull

Restlessness

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby; 2004:chap 155.

Updated by: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Timothy A. Rogge, MD, private practice in Psychiatry, Kirkland, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.