Agitation (medical)

Agitation is a state of heightened motor and cognitive activity characterized by excessive or inappropriate verbal and physical behaviors, emotional excitement, and restlessness, often arising as a symptom of underlying medical, psychiatric, or neurological conditions.^[1][2][3] It is considered both a medical and psychiatric emergency due to the potential for harm to patients, caregivers, and healthcare providers, and may escalate to aggression or violence if not promptly recognized and managed.^[1][4][5]

Agitation
Other names	Psychomotor agitation, restlessness
Specialty	Psychiatry, Neurology, Emergency medicine
Symptoms	Excessive motor activity, restlessness, pacing, hand-wringing, fidgeting, verbal outbursts
Complications	Injury, aggression, worsening of underlying condition
Usual onset	Variable
Duration	Variable, often acute
Causes	Psychiatric conditions (e.g. schizophrenia, bipolar disorder), delirium, substance use, withdrawal, medication side effects
Risk factors	Underlying psychiatric or neurological disorders, drug or alcohol use
Differential diagnosis	Anxiety, akathisia, delirium, psychosis
Prevention	Management of underlying conditions, medication adherence, early recognition
Treatment	Sedation, antipsychotics, benzodiazepines, behavioral interventions
Prognosis	Depends on cause and treatment
Frequency	Common in psychiatric and emergency settings

Causes

The etiology of agitation is multifactorial, encompassing acute medical illnesses (such as infections, metabolic disturbances, or pain), substance intoxication or withdrawal, delirium, and a spectrum of psychiatric disorders including mood, psychotic, and personality disorders.^[2][4][6]

Diagnosis

Early identification and a systematic evaluation to determine underlying causes are critical, as agitation of unknown origin should be presumed to have a medical cause until proven otherwise, particularly in populations such as the elderly or those without a prior psychiatric history.^[1][3]

Management

Effective management relies on a combination of non-pharmacological de-escalation strategies and, when necessary, targeted pharmacological interventions, always prioritizing the safety of all involved.^[2][5]