Agitation: Causes, Symptoms, and Management

Agitation: Understanding Its Causes, Symptoms, and Management Strategies

 

 

1. Introduction

Agitation is a complicated condition of arousal of emotions and bodily restlessness that expresses itself in numerous behavioral and mental signs. It is commonly referred to as a sense of inner tension that may result in over activity of the motor system, irritability, and even verbal or physical violence. Although it is not a diagnosis per se, agitation is a major clinical issue because it may indicate some underlying medical, psychiatric or neurological conditions or it may be a reaction to environmental stressors.

The importance of agitation in understanding is due to the fact that agitation may have a lot of consequences on the quality of life, safety, and well-being of an individual. It may create tension in a relationship, make it very difficult to provide medical care, and become a risk factor to health or lives. The groups of people that are found to be agitated are psychiatric patients, people with neurological disorders such as dementia, older people and patients with acute medical diseases. The article offers a broad summary of the concept of agitation, the possible reasons behind it, the range of symptoms that it can manifest, as well as the complex of the methods of addressing it, with the major focus on the non-pharmacological interventions.

 

2. Understanding Agitation

Agitation should be differentiated with other similar states. Although worry and fear are the main highlight of anxiety, agitation is more focused on the more motor aspect of it, pacing, hand-wringing or the inability to sit down. Aggression is a hostile or violent conduct which may be a possible result of intense agitation, but is not always the case. Restlessness is a vaguer, and not very specific symptom, of being uncomposed on the inside, but agitation is more severe and painful.

Agitation may be acute in nature, that is, it may occur abruptly as a response to a particular stimulus such as pain or infection, or it may be chronic, and lingering as a result of an ongoing illness such as bipolar disorder. Its severity is usually divided into five clinicians:

·       Mild: The person becomes even more fidgety and irritable, but can be redirected.

·       Moderate: Slow or rapid and loud speech and inabilities to follow instructions.

·       Severe: Threatening gestures, aggression, or total failure in responding to verbal intervention, and usually needs immediate action.

 

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3. Causes of Agitation

The agitation is hardly spontaneous; it is rather the symptom of a need that is not satisfied or a disorder which lies behind. It is the identification of the root cause which is the initial step to effective management.

3.1 Psychological and Psychiatric Causes

Agitation may be a fundamental symptom of many mental disorders.

·       Anxiety Disorders: The worrying can be accompanied with physical restlessness and irritability.

·       Depression: In some instances, especially in agitated depression, one can have psychic distress, accompanied by motor agitation.

·       Bipolar Disorder (Mania): The manic episodes are full of energy, impulsiveness, and sleep insensitivity, which appear to be extreme agitations at times.

·       Schizophrenia and Psychotic Disorders: Agitation can be a reaction to hallucinations or paranoia.

·       Post-Traumatic Stress Disorder (PTSD): Irritability and angry outbursts are among the hyperarousal symptoms.

3.2 Neurological Causes

Agitation is common in the brain through damage or degeneration.

·       Dementia and Alzheimer Disease: Agitation is among the typical behavioral and psychological symptoms, which are most likely to be caused by the confusion, fear, or the inability to express the needs.

·       Delirium: A state of acute confusion, usually as a result of a disease or a drug, usually characterized by agitation and a loss of orientation.

·       Traumatic Brain Injury (TBI): Frontal lobe damage may affect impulse control which results in irritability and agitation.

·       Parkinson Disease: Non-motor symptoms such as agitation may be present besides the motor symptoms, and at times, agitation may be aggravated by drugs.

·       Stroke: It may manifest as agitation during the acute recovery stages and specifically on those parts of the brain that have undergone stroke.

3.3 Medical and Physiological Causes

Agitation may occur whenever there is any type of disorder that interferes with the homeostasis of the body.

·       Pain and Discomfort: Unidentified or unattended pain is a highly prevalent cause of the same, particularly in non-verbal groups.

·       Infections: Diseases such as urinary tract infections (UTIs) or sepsis may lead to major behavioral changes such as agitation, especially among the elderly.

·       Metabolic Imbalances: A low level of sugar in the blood (hypoglycemia), electrolytes imbalance, or liver/kidney failure may influence the ability of the brain to perform its functions.

·       Hypoxia: Restlessness and anxiety may be a result of low oxygen levels in blood, caused by such illnesses as COPD or heart failure.

·       Hormonal Disorders: Thyroid disorders (hyperthyroidism) have similar attitude to anxiety and agitation.

3.4 Substance-Related Causes

One of the significant causes is the use or quit of substances.

·       Intoxication: The stimulants (cocaine, methamphetamine), large amounts of cannabis or alcohol would cause agitation.

·       Withdrawal States: Notoriously, withdrawal by alcohol, benzodiazepines, or opioids is characterized by severe agitation and anxiety.

·       Medication Side Effects: Some drugs such as steroids, antidepressants, and stimulants may contain agitation as one of their possible side effects.

3.5 Environmental and Social Factors

Outside environment is very essential, particularly among the vulnerable people.

·       Sensory Overload/ Deprivation: Too much noise/ light or vice versa, isolation and deprivation.

·       Sleep Deprivation: Habitual inadequate sleep is a severe reduction in frustration-tolerance.

·       Stressful or Unfamiliar Environments Hospitalization, a new residential care facility, or congested rooms.

·       Social Isolation: Socially isolated and lonely people may develop distress and agitation.

 

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4. Symptoms of Agitation

Agitation manifests itself in the form of a complex of behavioral, emotional, and physical symptoms.

4.1 Behavioral Symptoms

·       Irritability, pacing, lack of ability to be in a single location.

·       Monotonous actions such as wringing hands or scratching clothes/skin.

·       Cursing, screaming or using vulgar language.

·       Hypers irritability, impatience, or open aggression.

·       Resisting care or guidance.

4.2 Emotional and Cognitive Symptoms

·       Some inner tension or unease to the subject.

·       Increased anxiety, fear or feel threatened.

·       Misunderstanding, disorientation or inability to process information.

·       Lack of concentration and hyperactivity.

·       Sudden mood swings and emotional instability.

4.3 Physical Symptoms

·       Rapid heart rate and high blood pressure.

·       Flushing, shivering, or perspiring.

·       Squeezing of muscle, tightened lips, or fists.

·       Shallow, rapid breathing (tachypnea).

·       Dilated pupils.

5. Assessment and Diagnosis

Proper evaluation is critical since the management will rely fully on the cause of the problem. Agitation has no specific test. It is generally carried out in the following manner:

·       Clinical History: This is received by the patient and caregivers. The most important questions are based on onset, triggers, medical/psychiatric history, and medication/substance use.

·       Physical Examination: To determine infection signs, pain, losing of neurological functions, and metabolic problems.

·       Mental Status Examination: Evaluating mood, way of thinking, orientation and perception.

·       Laboratory Tests and Imaging: Blood tests, urinalysis or brain scan (such as CT scan) can be employed to eliminate medical conditions such as infection or metabolic imbalance.

·       Agitation Assessment Scales: It is possible to quantify and monitor symptoms by using such scales as the Agitation Behavior Mapping Instrument (ABMI) or the Cohen-Mansfield Agitation Inventory (CMAI) in the structured setting.

 

6. Management of Agitation

The management is concerned about safety and focuses on the cause. It is usually advisable to use a gradual process, beginning with the least interventions that are restrictive.

6.1 Non-Pharmacological Management

These are first line and cornerstone strategies.

·       De-escalation Techniques: Speaking in a calm respectful manner, personal space, slow speech, and no confronting body language.

·       Verbal Reassurance and Active Listening: Recognizing the distress in the person, empathetic statements and also trying to comprehend the unmet need of the person.

·       Environmental Adaptations: Minimizing noise and clutter, adequate lighting, and safe places to move around and comfortable objects.

·       Learning to Behave: In chronic agitation, such therapies as Cognitive Behavioral Therapy (CBT) can be utilized to make people recognize triggers and learn coping skills.

·       Involvement of Family and Caregivers: It is also important to educate and support the caregivers. Their skill to identify early symptoms and react without panic will help to avoid working up.

6.2 Pharmacological Management

Drug treatment can be taken into consideration in case of non-pharmacological treatment failure and agitation is a safety threat.

·       Indications to Medication Use: Generally used in case of moderate to severe agitation where there is a real threat of harm.

·       Technology Medication Classes: It depends on the cause. The antipsychotics, benzodiazepines, mood stabilizers, and antidepressants are some of the discussed options in the clinical literature. It is important to mention that any drug is associated with the risks of the side effects and should be prescribed by a qualified medical worker and dealt with.

·       Risks, Side Effects, and Ethical Issues: The application of medication, particularly in the vulnerable groups such as the older generation with dementia must be closely evaluated in terms of benefit and risk. Possible side effects, including sedation or high risk of falls, should be observed. Personal care and human interaction should always be a better choice than medication.

6.3 Management in Special Populations

·       Elderly Patients & Patients with Dementia: There is an excessive focus on non-drug approaches. It is essential that triggers such as pain, constipation, or infection should be pointed out. In case of antipsychotic use, the drugs considered have high risks and should be taken with extreme caution.

·       Children and Adolescents: The management is oriented to the strategies of behavior, family therapy, and building of positive school conditions.

·       Medically Unstable Patients: The major danger here is to stabilize the medical situation (e.g., an infection, hypoxia correction) which in many cases is curing the agitation.

 

7. Prevention Strategies

·       Early Trigger Determination: Having a diary to determine timing of day, surroundings or activities.

·       Stress Management Methods: Mindfulness or light exercising, or listening to soothing music.

·       Frequent Medical and Psychiatric Check-ups: Ongoing treatment of pre-existing chronic illness.

·       Medication Review: It is important to regularly discuss all medications with a doctor to determine which of them may cause agitation.

·       Supportive Care and Education: Making sure that the individuals and caregivers are knowledgeable of the condition and have resources and support groups.

 

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8. Complications of Untreated Agitation

Otherwise, agitation may result in:

·       High chances of harm to either the individual or the caregivers.

·       Exacerbation of the underlying disease as a result of stress and non-compliance.

·       Raised hospitalization or emergency.

·       Major burnout, stress, and depression of caregivers.

·       Lack of socialization and deterioration of quality of life.

 

9. Conclusion

Agitation is a complex disease requiring a careful approach to treatment, which is patient centered. It is an effective indicator of something being amiss, be it medical, psychological or environmental. The key to managing the problem is a thorough evaluation to identify the underlying cause and then a customized plan that puts the priority on non-pharmacological interventions. The team must comprise a multidisciplinary team comprising of doctors, nurses, therapists and above all informed caregivers to offer holistic care. Early detection, empathy, and determination to fulfill the unmet needs of the individual are the best way to minimize distress and improve the outcome of individuals who are agitated.

Disclaimer: the article is an informational source and it is not a replacement of a qualified medical advice and diagnosis and treatment. You should always consult your doctor or other trained health care practitioner on any concerns you might have on a medical condition.

 

10. FAQs

Q1: Do you think that agitation is the same as anxiety?

A: They are different although they tend to co-exist. The main characteristic of anxiety is being extremely worried and fearful. Agitation is a disorder with a high physical element (restlessness, pacing and excessive motor activity) and emotional distress.

 

Q2: What is the first thing that I should do should somebody become agitated?

A: Prioritize safety. Be gentle, use low, assuring tone, provide them with a lot of personal space and eliminate the environment triggers where possible. Easy questions should be asked to attempt to comprehend their need or their concern.

 

Q3: Does lifestyle intervention aid chronic agitation?

A: Yes, it can be of great help to some people, lifestyle changes. These may involve developing a consistent sleep habit, physical exercise, relaxation exercises such as deep breathing, limiting caffeine consumption and making the daily schedule regular.

 

Q4: What are the instances when I am supposed to seek professional help when agitating?

A: See professional assistance in case of severe agitation which threatens harm, is common and/or increasing or is disrupting normal life and interpersonal relationships. Symptoms Anxiety, agitation, particularly in an elderly person, which comes suddenly, should be examined immediately to exclude such causes as infection or delirium.

 

Q5: What can I do to help a caregiver who is experiencing agitation of a loved one?

A: The support of the caregivers is essential. Provide respite services to offer them a relaxation. Ask them to become a part of a support group. Assist them in utilizing educational materials on the underlying situation. Most importantly, be a non-judgmental listener and recognize the hardships that they undergo.

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