Agitation (also: agitation) is a state of internal agitation that is manifested by an insatiable urge to move. Agitation states can occur as a symptom of various illnesses, such as depression or dementia, or can occur as a side effect of taking certain medications. Drug use or drug withdrawal can also cause agitation.
Agitation or nervousness?
It is important to distinguish agitation from simple restlessness or nervousness, as medical treatment may be needed for an agitation condition. Here’s how to recognize agitation and what to do about it. The characteristic feature of agitation is the excessive need to move. Agitated individuals usually pace up and down restlessly and are unable to sit still. In addition, they often exhibit uncontrolled, aimless movement patterns such as fidgeting, constantly picking at their own clothing, or casually handling objects. In psychology, these behaviors are grouped under the term “increased psychomotor activity.”
Unrestrained urge to move as a sign
Patients themselves usually experience a strong inner tension and restlessness when they are in a state of agitation. However, unlike people who are generally nervous or feel tense in a stressful situation, agitated individuals are unable to suppress the urge to move. This is often accompanied by increased irritability up to aggressive behavior and uncontrolled outbursts of anger. In rare cases, temporary placement in a psychiatric hospital may then even be necessary in order to avoid endangering the affected person himself or others.
Causes and triggers
Agitation can be caused by a variety of causes:
- In the context of mental illnesses such as dementia, depression, schizophrenia, borderline personality disorder, and anxiety disorder, as well as acute psychological stress, agitation may occur as a symptom.
- Drug use, alcohol abuse, and alcohol or drug withdrawal can each cause agitation, especially if it causes a disturbance of consciousness (delirium).
- Organic diseases such as severe hyperthyroidism, epilepsy, derailment of metabolism (for example, in diabetes)or electrolytes, as well as an asthma attack or oxygen deficiency can trigger a state of agitation.
- If signs of agitation occur in children, this may be an indication of attention deficit hyperactivity disorder (ADHD). In this case, an excessive urge to move is usually accompanied by severe concentration problems and a tendency to impulsive actions. If you notice these symptoms in enormously pronounced form in your child, you should seek advice from a pediatrician or a child psychologist.
Agitated depression
Agitated depression is a special form of depressive disorder, as the symptoms sometimes differ from the typical signs of depression. While patients with classic depression usually complain of listlessness and show a slowing of movement, agitated depression is characterized by restlessness and drive. In addition, there are usually agonizing anxiety states and strong inner restlessness. In some cases, this can lead to impulsive actions and thus to an increased risk of suicide. It is therefore important to interpret the symptoms correctly and to initiate psychotherapeutic treatment at an early stage.
Agitation as a side effect of medication
Agitation can occur as a side effect of certain medications. For example, a so-called paradoxical reaction can occur when taking sedatives such as benzodiazepines or opioid painkillers such as morphine. In this case, the patient experiences a state of agitation, even though the drug is supposed to have a calming effect. Drugs for depression such as venlafaxine or lithium, as well as cortisone-like agents, can also lead to agitation. This is especially the case if they are overdosed. Occasionally, agitation is also observed after surgery as a side effect of anesthesia.
Agitation: providing calm and reassurance
Facing an agitated person, it is first of all important to remain calm and radiate composure.Signal that help is possible, because the patient’s condition is usually highly frightening. Create a calm situation and, if possible, eliminate disturbing stimuli. Under certain circumstances, it may be useful to ask other people to leave the room. However, if the affected person shows aggressive behavior and thus poses a possible danger to himself or others, you should not hesitate to call the emergency services. This is because if the agitation is severe, it may be necessary for the patient to be treated with sedatives (benzodiazepines). In very severe cases, the emergency physician must admit the patient to a psychiatric hospital to avert danger to himself or others. However, even if the affected person calms down and the agitation subsides, a state of agitation should always be clarified by a physician or a psychotherapist to find out the underlying cause.
Increased risk of injury in dementia
Dealing with agitation is particularly difficult in persons with dementia. This is because, on the one hand, those affected are usually unable to grasp the situation due to their limited mental ability, which makes it difficult to have a calming conversation. On the other hand, such a state of agitation, which also often occurs at night, increases the risk of injury and falls for the patient. Treatment of agitation with tranquilizers also carries an increased risk in elderly persons with dementia, as these drugs additionally restrict motor and mental abilities. Scented aromas and soothing music can be used as useful adjuncts to drug therapy.
