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Definition

Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.

Alternative Names

Restlessness

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 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

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.