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{{short description|Spectrum of disorders characterized by unintentional and purposeless motions and restlessness}}
{{Short description|Medical condition characterized by unintentional and purposeless motions and restlessness}}
{{Use dmy dates|date=April 2019}}
{{Use dmy dates|date=April 2019}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Psychomotor agitation
| name = Psychomotor agitation
| synonyms = Pacing
| synonyms = Pacing
| image =
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| field = [[Psychiatry]], [[emergency medicine]]
| field = [[Psychiatry]], [[emergency medicine]]
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'''Psychomotor agitation''' is a spectrum of disorders characterized by unintentional and purposeless motions and restlessness, often accompanied by emotional distress, but not always. Typical manifestations include pacing around a room, wringing the hands, uncontrolled tongue movement, pulling off clothing and putting it back on, and other similar actions. In more severe cases, the motions may become harmful to the individual, such as [[Dermatillomania|ripping]], tearing, or chewing at the skin around one's fingernails, lips, or other body parts to the point of bleeding. Psychomotor agitation is typically found in [[major depressive disorder]] or [[obsessive-compulsive disorder]], and sometimes the manic phase in [[bipolar disorder]], though it can also be a result of an excess intake of [[stimulants]]. It can also be caused by severe [[hyponatremia]]. The middle-aged and the elderly are more at risk to express it.
'''Psychomotor agitation''' is a [[symptom]] in various [[disease|disorder]]s and health conditions<!--Wording "disorders and health conditions" because not all neurodiversity is disordered.-->. It is characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress and is always an indicative for discharge. Typical manifestations include pacing around, wringing of the hands, uncontrolled tongue movement, pulling off clothing and putting it back on, and other similar actions.<ref>{{Cite web|last=Burgess|first=Lana|date=October 16, 2017|title=What is psychomotor agitation?|url=https://www.medicalnewstoday.com/articles/319711#what-is-psychomotor-agitation|access-date=June 13, 2021|website=Medical News Today}}</ref> In more severe cases, the motions may become harmful to the individual, and may involve things such as [[Dermatillomania|ripping]], tearing, or chewing at the skin around one's fingernails, lips, or other body parts to the point of bleeding. Psychomotor agitation is typically found in various mental disorders, especially in psychotic and mood disorders. It can be a result of drug intoxication or withdrawal. It can also be caused by severe [[hyponatremia]]. People with existing psychiatric disorders and men under the age of 40 are at a higher risk of developing psychomotor agitation. <ref name=":0">{{Cite web |date=2024-12-10 |title=Protocol for the management of psychiatric patients with psychomotor agitation |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC5591519/ |archive-url=https://web.archive.org/web/20241210102851/https://pmc.ncbi.nlm.nih.gov/articles/PMC5591519/ |archive-date=2024-12-10 |access-date=2024-12-10 |website=National Library of Medicine}}</ref>


Psychomotor agitation overlaps with agitation generally, such as [[agitation (dementia)|agitation in predementia and dementia]]; see ''[[Agitation (dementia)]]'' for details.
⚫
== Signs and symptoms ==
People experiencing psychomotor agitation may feel or do:


⚫
== Signs and symptoms ==
People experiencing psychomotor agitation may feel the following emotions or do the following actions. Some of these actions are not inherently harmful, but may be evaluated as psychomotor agitation as these symptoms may escalate and become dangerous.<ref name=":0" />
* unable to sit still
* unable to sit still
* fidgeting
* fidgeting
* as if their body is stiff
* body stiffness
* unable to relieve tension
* unable to relieve tension
* desperate to find a comfortable position
* desperate to find a comfortable position
Line 38: Line 39:
* exasperated
* exasperated
* tearful
* tearful
* extreme irritability, like snapping at friends and family, or being annoyed at small things
* extreme irritability, like snapping at friends and family, or being annoyed by small things
* anger
* anger
* agitation
* agitation
Line 45: Line 46:
* pacing
* pacing
* hand-wringing
* hand-wringing
* self-hugging
* nail-biting
* nail-biting
* outbursts of complaining or shouting
* outbursts of complaining or shouting
* pulling at clothes or hair
* pulling at clothes or hair
* picking at skin, as either a sign of PMA or even progressing to a disorder ([[excoriation disorder]])
* picking at skin
* tapping fingers
* tapping fingers
* tapping feet
* tapping feet
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==Causes==
==Causes==
Causes include:<ref>[http://www.rightdiagnosis.com/symptoms/psychomotor_agitation/causes.htm Causes of Psychomotor agitation] {{webarchive|url=https://web.archive.org/web/20160311195003/http://www.rightdiagnosis.com/symptoms/psychomotor_agitation/causes.htm |date=2016-03-11 }}, Retrieved 11 March 2016.</ref>
Causes include:<ref>[http://www.rightdiagnosis.com/symptoms/psychomotor_agitation/causes.htm Causes of Psychomotor agitation] {{webarchive|url=https://web.archive.org/web/20160311195003/http://www.rightdiagnosis.com/symptoms/psychomotor_agitation/causes.htm |date=2016-03-11 }}, Retrieved 11 March 2016.</ref>
*[[Schizophrenia]]
* [[Schizophrenia]]
*[[Bipolar disorder]]
* [[Bipolar disorder]]
⚫
* [[Post-traumatic stress disorder|Post-traumatic stress disorder (PTSD)]]
*[[Excited delirium]]
* [[Panic attacks]]
⚫
*[[Post-traumatic stress disorder|Post-traumatic stress disorder (PTSD)]]
*[[Panic attacks]]
* [[Anxiety disorder]]
⚫
* [[Obsessive–compulsive disorder|Obsessive-compulsive disorder (OCD)]]
*[[Anxiety disorder]]
* [[Nicotine withdrawal]]
⚫
*[[Obsessive–compulsive disorder|Obsessive-compulsive disorder (OCD)]]
*[[Nicotine withdrawal]]
* [[Alcohol withdrawal]]
*[[Alcohol withdrawal]]
* [[Opioid withdrawal]]
* [[Autism]]
*[[Opioid withdrawal|Opioid Withdrawal]]
*[[Autism]]
* [[Asperger syndrome]]
*[[Claustrophobia]]
* [[Claustrophobia]]
* [[Intellectual disability]]
⚫
*[[Dementia]]
* [[Attention deficit hyperactivity disorder]]
⚫
*[[Parkinson's disease]]
⚫
* [[Dementia]]
⚫
*[[Traumatic brain injury]]
⚫
* [[Parkinson's disease]]
⚫
* [[Traumatic brain injury]]
* [[Alzheimer's disease]]<ref>{{cite journal | vauthors = Koenig AM, Arnold SE, Streim JE | title = Agitation and Irritability in Alzheimer's Disease: Evidenced-Based Treatments and the Black-Box Warning | journal = Current Psychiatry Reports | volume = 18 | issue = 1 | pages = 3 | date = January 2016 | pmid = 26695173 | pmc = 6483820 | doi = 10.1007/s11920-015-0640-7 }}</ref>
* [[Alzheimer's disease]]<ref>{{cite journal | vauthors = Koenig AM, Arnold SE, Streim JE | title = Agitation and Irritability in Alzheimer's Disease: Evidenced-Based Treatments and the Black-Box Warning | journal = Current Psychiatry Reports | volume = 18 | issue = 1 | pages = 3 | date = January 2016 | pmid = 26695173 | pmc = 6483820 | doi = 10.1007/s11920-015-0640-7 }}</ref>
*[[Acute intermittent porphyria]]<ref>{{Cite news|url=http://www.porphyriafoundation.com/about-porphyria/types-of-porphyria/AIP|title=Acute Intermittent Porphyria (AIP)|date=2009-02-18|work=American Porphyria Foundation|access-date=2017-12-08|archive-url=https://web.archive.org/web/20151002041011/http://www.porphyriafoundation.com/about-porphyria/types-of-porphyria/AIP|archive-date=2 October 2015|url-status=dead}}</ref>{{verify source|date=January 2017}}
* [[Acute intermittent porphyria]]<ref>{{Cite news|url=http://www.porphyriafoundation.com/about-porphyria/types-of-porphyria/AIP|title=Acute Intermittent Porphyria (AIP)|date=2009-02-18|work=American Porphyria Foundation|access-date=2017-12-08|archive-url=https://web.archive.org/web/20151002041011/http://www.porphyriafoundation.com/about-porphyria/types-of-porphyria/AIP|archive-date=2 October 2015|url-status=dead}}</ref>{{verify source|date=January 2017}}
*[[Hereditary coproporphyria]]
* [[Hereditary coproporphyria]]
*[[Variegate porphyria]]
* [[Variegate porphyria]]
*Side effects of drugs like [[cocaine]] or [[methylphenidate]]
* Side effects of stimulants such as [[cocaine]] or [[methylphenidate]]
*Side effects of antipsychotics like [[haloperidol]]
* Side effects of antipsychotics like [[haloperidol]]
⚫
* [[Selective serotonin reuptake inhibitor|SSRI]] or [[Serotonin-norepinephrine reuptake inhibitor|SNRI]] medications
*[[Major depressive disorder]] <ref name=":0">{{Cite news|url=https://www.healthline.com/health/agitated-depression#symptoms|title=Agitated Depression: Symptoms, Treatment, and Outlook|work=Healthline|access-date=2018-07-31}}</ref>
⚫
As explained in a 2008 study, in people with mood disorders there is a dynamic link between their mood and the way they move.<ref name=":1">{{cite web |url= https://www.medicalnewstoday.com/articles/319711.php |title=What is psychomotor agitation? | work = Medical News Today |date=16 October 2017 }}</ref>
*Agitated depression <ref name=":0" />
⚫
*[[Selective serotonin reuptake inhibitor|SSRI]] or [[Serotonin-norepinephrine reuptake inhibitor|SNRI]] medications
⚫
As explained in a 2008 study, in people with mood disorders there is a dynamic link between their mood and the way they move.<ref name=":1">{{cite web |url= https://www.medicalnewstoday.com/articles/319711.php |title=What is psychomotor agitation? | work = Medical News Today }}</ref>


People showing signs of psychomotor agitation may be experiencing mental tension and anxiety, which comes out physically as:
People showing signs of psychomotor agitation may be experiencing mental tension and anxiety, which comes out physically as:

* fast or repetitive movements
* fast or repetitive movements
* movements that have no purpose
* movements that have no purpose
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Sometimes, however, psychomotor agitation does not relate to mental tension and anxiety.
Sometimes, however, psychomotor agitation does not relate to mental tension and anxiety.


Recent studies found that nicotine withdrawal induces psychomotor agitation (motor deficit).<ref>{{cite journal | vauthors = Hughes JR | title = Effects of abstinence from tobacco: valid symptoms and time course | journal = Nicotine Tob Res | volume = 9 | issue = 3 | pages = 315–327 | date = 2007 | doi = 10.1080/14622200701188919 | pmid = 17365764 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Grundey J et al. | title = Diverging effects of nicotine on motor learning performance: Improvement in deprived smokers and attenuation in non-smokers | journal = Addict. Behav. | volume = 74 | pages = 90–97 | date = 2017 | pmid = 28600927 | doi = 10.1016/j.addbeh.2017.05.017 }}</ref><ref>{{cite journal |vauthors=Becker JA, Kieffer BL, Le Merrer J | title = Differential behavioral and molecular alterations upon protracted abstinence from cocaine versus morphine, nicotine, THC and alcohol | journal = Addiction Biology | volume = 22 | issue = 5 | pages = 1205–1217 | date = 2017 | pmid = 27126842 | doi = 10.1111/adb.12405 | pmc = 5085894 }}</ref><ref>{{cite journal | vauthors = Kim B, Im HI | title = Chronic nicotine impairs sparse motor learning via striatal fast‐spiking parvalbumin interneurons | journal = Addiction Biology | volume = Early View | date = 2020 | issue = 3 | pages = e12956 | pmid = 32767546 | doi = 10.1111/adb.12956 | doi-access = free }}</ref>
Recent studies found that nicotine withdrawal induces psychomotor agitation (motor deficit).<ref>{{cite journal | vauthors = Hughes JR | title = Effects of abstinence from tobacco: valid symptoms and time course | journal = Nicotine Tob Res | volume = 9 | issue = 3 | pages = 315–327 | date = 2007 | doi = 10.1080/14622200701188919 | pmid = 17365764 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Grundey J et al. | title = Diverging effects of nicotine on motor learning performance: Improvement in deprived smokers and attenuation in non-smokers | journal = Addict. Behav. | volume = 74 | pages = 90–97 | date = 2017 | pmid = 28600927 | doi = 10.1016/j.addbeh.2017.05.017 }}</ref><ref>{{cite journal |vauthors=Becker JA, Kieffer BL, Le Merrer J | title = Differential behavioral and molecular alterations upon protracted abstinence from cocaine versus morphine, nicotine, THC and alcohol | journal = Addiction Biology | volume = 22 | issue = 5 | pages = 1205–1217 | date = 2017 | pmid = 27126842 | doi = 10.1111/adb.12405 | pmc = 5085894 }}</ref><ref>{{cite journal | vauthors = Kim B, Im HI | title = Chronic nicotine impairs sparse motor learning via striatal fast-spiking parvalbumin interneurons | journal = Addiction Biology | volume = Early View | date = 2020 | issue = 3 | pages = e12956 | pmid = 32767546 | doi = 10.1111/adb.12956 | pmc = 8243919 | doi-access = free }}</ref>



In other cases, psychomotor agitation can be caused by [[antipsychotic]] medications. For instance, [[akathisia]], a movement disorder sometimes induced by antipsychotics and other [[Psychoactive drug|psychotropics]], is estimated to affect 15-35% of patients with schizophrenia.<ref>{{cite journal | vauthors = Berna F, Misdrahi D, Boyer L, Aouizerate B, Brunel L, Capdevielle D, Chereau I, Danion JM, Dorey JM, Dubertret C, Dubreucq J, Faget C, Gabayet F, Lancon C, Mallet J, Rey R, Passerieux C, Schandrin A, Schurhoff F, Tronche AM, Urbach M, Vidailhet P, Llorca PM, Fond G | display-authors = 6 | title = Akathisia: prevalence and risk factors in a community-dwelling sample of patients with schizophrenia. Results from the FACE-SZ dataset | journal = Schizophrenia Research | volume = 169 | issue = 1–3 | pages = 255–261 | date = December 2015 | pmid = 26589388 | doi = 10.1016/j.schres.2015.10.040 | s2cid = 26752064 | url = http://www.sciencedirect.com/science/article/pii/S0920996415300402 }}</ref><ref>{{cite journal | vauthors = Salem H, Nagpal C, Pigott T, Teixeira AL | title = Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges | journal = Current Neuropharmacology | volume = 15 | issue = 5 | pages = 789–798 | date = 2017-06-15 | pmid = 27928948 | pmc = 5771055 | doi = 10.2174/1570159X14666161208153644 }}</ref>
In other cases, psychomotor agitation can be caused by [[antipsychotic]] medications. For instance, [[akathisia]], a movement disorder sometimes induced by antipsychotics and other [[Psychoactive drug|psychotropics]], is estimated to affect 15-35% of patients with schizophrenia.<ref>{{cite journal | vauthors = Berna F, Misdrahi D, Boyer L, Aouizerate B, Brunel L, Capdevielle D, Chereau I, Danion JM, Dorey JM, Dubertret C, Dubreucq J, Faget C, Gabayet F, Lancon C, Mallet J, Rey R, Passerieux C, Schandrin A, Schurhoff F, Tronche AM, Urbach M, Vidailhet P, Llorca PM, Fond G | display-authors = 6 | title = Akathisia: prevalence and risk factors in a community-dwelling sample of patients with schizophrenia. Results from the FACE-SZ dataset | journal = Schizophrenia Research | volume = 169 | issue = 1–3 | pages = 255–261 | date = December 2015 | pmid = 26589388 | doi = 10.1016/j.schres.2015.10.040 | s2cid = 26752064 | url = http://www.sciencedirect.com/science/article/pii/S0920996415300402 }}</ref><ref>{{cite journal | vauthors = Salem H, Nagpal C, Pigott T, Teixeira AL | title = Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges | journal = Current Neuropharmacology | volume = 15 | issue = 5 | pages = 789–798 | date = 2017-06-15 | pmid = 27928948 | pmc = 5771055 | doi = 10.2174/1570159X14666161208153644 }}</ref>


==Diagnosis==
{{Empty section|date=July 2022}}
==Treatment==
==Treatment==
A form of self-treatment arises in that many patients develop [[stimming]] in a natural, unplanned, and largely nonconscious way, simply because they coincidentally discover behavior that brings some relief to their psychomotor agitation, and develop [[habit]]s around it. Stimming has many forms, some quite adaptive and others [[wikt:maladaptive#Adjective|maladaptive]] (for example, excessive hand-wringing can injure joints, and excessive rubbing or scratching of skin can injure it). Another form of self-treatment that arises not uncommonly is [[self-medication]], which unfortunately can lead to [[substance use disorder]]s such as [[alcohol use disorder]].{{cn|date=July 2022}}
⚫
[[intramuscular injection|Intramuscular]] [[midazolam]], [[lorazepam]], or another [[benzodiazepine]] can be used to both sedate agitated patients, and control semi-involuntary muscle movements in cases of suspected [[akathisia]].

⚫
[[Droperidol]], [[haloperidol]], or other [[typical antipsychotics]] can decrease the duration of agitation caused by acute [[psychosis]], but should be avoided if the agitation is suspected to be [[akathisia]], which can be potentially worsened.<ref>{{cite journal | vauthors = Isbister GK, Calver LA, Page CB, Stokes B, Bryant JL, Downes MA | title = Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study | journal = Annals of Emergency Medicine | volume = 56 | issue = 4 | pages = 392–401.e1 | date = October 2010 | pmid = 20868907 | doi = 10.1016/j.annemergmed.2010.05.037 }}</ref> Also using [[promethazine]] may be useful.<ref>{{cite journal | vauthors = Ostinelli EG, Brooke-Powney MJ, Li X, Adams CE | title = Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation) | journal = The Cochrane Database of Systematic Reviews | volume = 7 | pages = CD009377 | date = July 2017 | pmid = 28758203 | pmc = 6483410 | doi = 10.1002/14651858.CD009377.pub3 }}</ref> Recently, three atypical antipsychotics, [[olanzapine]], [[aripiprazole]] and [[ziprasidone]], have become available and FDA approved as an instant release intramuscular injection formulations to control acute agitation. The IM formulations of these three atypical antipsychotics are considered to be at least as effective or even more effective than the IM administration of haloperidol alone or haloperidol with lorazepam<ref>{{cite journal | vauthors = Huang CL, Hwang TJ, Chen YH, Huang GH, Hsieh MH, Chen HH, Hwu HG | title = Intramuscular olanzapine versus intramuscular haloperidol plus lorazepam for the treatment of acute schizophrenia with agitation: An open-label, randomized controlled trial | journal = Journal of the Formosan Medical Association = Taiwan Yi Zhi | volume = 114 | issue = 5 | pages = 438–45 | date = May 2015 | pmid = 25791540 | doi = 10.1016/j.jfma.2015.01.018 }}</ref><ref>{{Cite journal| vauthors = Citrome L, Brook S, Warrington L, Loebel A, Mandel FS |date=October 2004|title=Ziprasidone versus haloperidol for the treatment of agitation |url= https://www.annemergmed.com/article/S0196-0644(04)00796-6/abstract |journal=Annals of Emergency Medicine |volume=44 |issue=4 |pages=S22 |doi=10.1016/j.annemergmed.2004.07.073 }}</ref><ref>{{cite journal | vauthors = Cañas F | title = Management of agitation in the acute psychotic patient--efficacy without excessive sedation | language = English | journal = European Neuropsychopharmacology | volume = 17 Suppl 2 | pages = S108-14 | date = March 2007 | pmid = 17336765 | doi = 10.1016/j.euroneuro.2007.02.004 | s2cid = 14534413 }}</ref> (which is the standard treatment of agitation in most hospitals) and the atypicals have a dramatically improved tolerability due to a milder side-effect profile.

⚫
In those with [[psychosis]] causing agitation there is a lack of support for the use of [[benzodiazepines]] alone, however they are commonly used in combination with antipsychotics since they can prevent side effects associated with [[dopamine antagonists]].<ref>{{cite journal | vauthors = Gillies D, Sampson S, Beck A, Rathbone J | title = Benzodiazepines for psychosis-induced aggression or agitation | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD003079 | date = April 2013 | pmid = 23633309 | doi = 10.1002/14651858.CD003079.pub3 | hdl = 10454/16512 | hdl-access = free }}</ref>

Also, introducing the following lifestyle changes to their routine may help a person to reduce their anxiety levels:<ref name=":1" />


Whereas stimming is a nonpharmacologic but undirected and sometimes harmful amelioration, directed [[therapy]] tries to introduce another and generally better nonpharmacologic help in the form of the following lifestyle changes, to help a person to reduce their anxiety levels:<ref name=":1" />
* regular [[exercise]]
* regular [[exercise]]
* [[yoga]] and [[meditation]]
* [[yoga]] and [[meditation]]
* deep breathing exercises
* deep breathing exercises

⚫
Because nonpharmacologic treatment by itself is often not enough, medications are also often used. [[intramuscular injection|Intramuscular]] [[midazolam]], [[lorazepam]], or another [[benzodiazepine]] can be used both to sedate agitated patients and to control semi-involuntary muscle movements in cases of suspected [[akathisia]].

⚫
[[Droperidol]], [[haloperidol]], or other [[typical antipsychotics]] can decrease the duration of agitation caused by acute [[psychosis]], but should be avoided if the agitation is suspected to be [[akathisia]], which can be potentially worsened.<ref>{{cite journal | vauthors = Isbister GK, Calver LA, Page CB, Stokes B, Bryant JL, Downes MA | title = Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study | journal = Annals of Emergency Medicine | volume = 56 | issue = 4 | pages = 392–401.e1 | date = October 2010 | pmid = 20868907 | doi = 10.1016/j.annemergmed.2010.05.037 }}</ref> Also using [[promethazine]] may be useful.<ref>{{cite journal | vauthors = Ostinelli EG, Brooke-Powney MJ, Li X, Adams CE | title = Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation) | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD009377 | date = July 2017 | issue = 7 | pmid = 28758203 | pmc = 6483410 | doi = 10.1002/14651858.CD009377.pub3 }}</ref> Recently, three atypical antipsychotics, [[olanzapine]], [[aripiprazole]] and [[ziprasidone]], have become available and FDA approved as an instant release intramuscular injection formulations to control acute agitation. The IM formulations of these three atypical antipsychotics are considered to be at least as effective or even more effective than the IM administration of haloperidol alone or haloperidol with lorazepam<ref>{{cite journal | vauthors = Huang CL, Hwang TJ, Chen YH, Huang GH, Hsieh MH, Chen HH, Hwu HG | title = Intramuscular olanzapine versus intramuscular haloperidol plus lorazepam for the treatment of acute schizophrenia with agitation: An open-label, randomized controlled trial | journal = Journal of the Formosan Medical Association = Taiwan Yi Zhi | volume = 114 | issue = 5 | pages = 438–45 | date = May 2015 | pmid = 25791540 | doi = 10.1016/j.jfma.2015.01.018 | doi-access = }}</ref><ref>{{Cite journal| vauthors = Citrome L, Brook S, Warrington L, Loebel A, Mandel FS |date=October 2004|title=Ziprasidone versus haloperidol for the treatment of agitation |url= https://www.annemergmed.com/article/S0196-0644(04)00796-6/abstract |journal=Annals of Emergency Medicine |volume=44 |issue=4 |pages=S22 |doi=10.1016/j.annemergmed.2004.07.073 }}</ref><ref>{{cite journal | vauthors = Cañas F | title = Management of agitation in the acute psychotic patient--efficacy without excessive sedation | language = English | journal = European Neuropsychopharmacology | volume = 17 | pages = S108-14 | date = March 2007 | issue = Suppl 2 | pmid = 17336765 | doi = 10.1016/j.euroneuro.2007.02.004 | s2cid = 14534413 }}</ref> (which is the standard treatment of agitation in most hospitals) and the atypicals have a dramatically improved tolerability due to a milder side-effect profile.

⚫
In those with [[psychosis]] causing agitation, there is a lack of support for the use of [[benzodiazepines]] alone, however they are commonly used in combination with antipsychotics since they can prevent side effects associated with [[dopamine antagonists]].<ref>{{cite journal | vauthors = Gillies D, Sampson S, Beck A, Rathbone J | title = Benzodiazepines for psychosis-induced aggression or agitation | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD003079 | date = April 2013 | pmid = 23633309 | doi = 10.1002/14651858.CD003079.pub3 | hdl = 10454/16512 | hdl-access = free }}</ref>


== See also ==
== See also ==
*[[Agitation (dementia)]]
* [[Agitation (dementia)]]
*[[Akathisia]]
* [[Akathisia]]
*[[Body-focused repetitive behavior]]
* [[Body-focused repetitive behavior]]
*[[Excited delirium]]
* [[Excited delirium]]


== References ==
== References ==
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== External links ==
== External links ==
{{Medical resources
{{Medical resources
| DiseasesDB =
| DiseasesDB =
| ICD10 =
| ICD10 =
| ICD9 = {{ICD9|308.2}}
| ICD9 = {{ICD9|308.2}}
| ICDO =
| ICDO =
| OMIM =
| OMIM =
| MedlinePlus =
| MedlinePlus =
| eMedicineSubj =
| eMedicineSubj =
| eMedicineTopic =
| eMedicineTopic =
| MeshID = D011595
| MeshID = D011595
}}
}}
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{{emotion-footer}}


[[Category:Symptoms and signs of mental disorders]]
{{DEFAULTSORT:Psychomotor Agitation}}
[[Category:Abnormal psychology]]

Latest revision as of 00:35, 12 December 2024

Psychomotor agitation
Other namesPacing
SpecialtyPsychiatry, emergency medicine

Psychomotor agitation is a symptom in various disorders and health conditions. It is characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress and is always an indicative for discharge. Typical manifestations include pacing around, wringing of the hands, uncontrolled tongue movement, pulling off clothing and putting it back on, and other similar actions.[1] In more severe cases, the motions may become harmful to the individual, and may involve things such as ripping, tearing, or chewing at the skin around one's fingernails, lips, or other body parts to the point of bleeding. Psychomotor agitation is typically found in various mental disorders, especially in psychotic and mood disorders. It can be a result of drug intoxication or withdrawal. It can also be caused by severe hyponatremia. People with existing psychiatric disorders and men under the age of 40 are at a higher risk of developing psychomotor agitation. [2]

Psychomotor agitation overlaps with agitation generally, such as agitation in predementia and dementia; see Agitation (dementia) for details.

Signs and symptoms

[edit]

People experiencing psychomotor agitation may feel the following emotions or do the following actions. Some of these actions are not inherently harmful, but may be evaluated as psychomotor agitation as these symptoms may escalate and become dangerous.[2]

  • unable to sit still
  • fidgeting
  • body stiffness
  • unable to relieve tension
  • desperate to find a comfortable position
  • increasingly anxious
  • exasperated
  • tearful
  • extreme irritability, like snapping at friends and family, or being annoyed by small things
  • anger
  • agitation
  • racing thoughts and incessant talking
  • restlessness
  • pacing
  • hand-wringing
  • self-hugging
  • nail-biting
  • outbursts of complaining or shouting
  • pulling at clothes or hair
  • picking at skin, as either a sign of PMA or even progressing to a disorder (excoriation disorder)
  • tapping fingers
  • tapping feet
  • starting and stopping tasks abruptly
  • talking very quickly
  • moving objects around for no reason
  • taking off clothes then putting them back on

Causes

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Causes include:[3]

As explained in a 2008 study, in people with mood disorders there is a dynamic link between their mood and the way they move.[6]

People showing signs of psychomotor agitation may be experiencing mental tension and anxiety, which comes out physically as:

  • fast or repetitive movements
  • movements that have no purpose
  • movements that are not intentional

These activities are the subconscious mind's way of trying to relieve tension[citation needed]. Often people experiencing psychomotor agitation feel as if their movements are not deliberate.

Sometimes, however, psychomotor agitation does not relate to mental tension and anxiety.

Recent studies found that nicotine withdrawal induces psychomotor agitation (motor deficit).[7][8][9][10]

In other cases, psychomotor agitation can be caused by antipsychotic medications. For instance, akathisia, a movement disorder sometimes induced by antipsychotics and other psychotropics, is estimated to affect 15-35% of patients with schizophrenia.[11][12]

Diagnosis

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Treatment

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A form of self-treatment arises in that many patients develop stimming in a natural, unplanned, and largely nonconscious way, simply because they coincidentally discover behavior that brings some relief to their psychomotor agitation, and develop habits around it. Stimming has many forms, some quite adaptive and others maladaptive (for example, excessive hand-wringing can injure joints, and excessive rubbing or scratching of skin can injure it). Another form of self-treatment that arises not uncommonly is self-medication, which unfortunately can lead to substance use disorders such as alcohol use disorder.[citation needed]

Whereas stimming is a nonpharmacologic but undirected and sometimes harmful amelioration, directed therapy tries to introduce another and generally better nonpharmacologic help in the form of the following lifestyle changes, to help a person to reduce their anxiety levels:[6]

Because nonpharmacologic treatment by itself is often not enough, medications are also often used. Intramuscular midazolam, lorazepam, or another benzodiazepine can be used both to sedate agitated patients and to control semi-involuntary muscle movements in cases of suspected akathisia.

Droperidol, haloperidol, or other typical antipsychotics can decrease the duration of agitation caused by acute psychosis, but should be avoided if the agitation is suspected to be akathisia, which can be potentially worsened.[13] Also using promethazine may be useful.[14] Recently, three atypical antipsychotics, olanzapine, aripiprazole and ziprasidone, have become available and FDA approved as an instant release intramuscular injection formulations to control acute agitation. The IM formulations of these three atypical antipsychotics are considered to be at least as effective or even more effective than the IM administration of haloperidol alone or haloperidol with lorazepam[15][16][17] (which is the standard treatment of agitation in most hospitals) and the atypicals have a dramatically improved tolerability due to a milder side-effect profile.

In those with psychosis causing agitation, there is a lack of support for the use of benzodiazepines alone, however they are commonly used in combination with antipsychotics since they can prevent side effects associated with dopamine antagonists.[18]

See also

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References

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  1. ^ Burgess, Lana (16 October 2017). "What is psychomotor agitation?". Medical News Today. Retrieved 13 June 2021.
  2. ^ a b "Protocol for the management of psychiatric patients with psychomotor agitation". National Library of Medicine. 10 December 2024. Archived from the original on 10 December 2024. Retrieved 10 December 2024.
  3. ^ Causes of Psychomotor agitation Archived 2016-03-11 at the Wayback Machine, Retrieved 11 March 2016.
  4. ^ Koenig AM, Arnold SE, Streim JE (January 2016). "Agitation and Irritability in Alzheimer's Disease: Evidenced-Based Treatments and the Black-Box Warning". Current Psychiatry Reports. 18 (1): 3. doi:10.1007/s11920-015-0640-7. PMC 6483820. PMID 26695173.
  5. ^ "Acute Intermittent Porphyria (AIP)". American Porphyria Foundation. 18 February 2009. Archived from the original on 2 October 2015. Retrieved 8 December 2017.
  6. ^ a b "What is psychomotor agitation?". Medical News Today. 16 October 2017.
  7. ^ Hughes JR (2007). "Effects of abstinence from tobacco: valid symptoms and time course". Nicotine Tob Res. 9 (3): 315–327. doi:10.1080/14622200701188919. PMID 17365764.
  8. ^ Grundey J, et al. (2017). "Diverging effects of nicotine on motor learning performance: Improvement in deprived smokers and attenuation in non-smokers". Addict. Behav. 74: 90–97. doi:10.1016/j.addbeh.2017.05.017. PMID 28600927.
  9. ^ Becker JA, Kieffer BL, Le Merrer J (2017). "Differential behavioral and molecular alterations upon protracted abstinence from cocaine versus morphine, nicotine, THC and alcohol". Addiction Biology. 22 (5): 1205–1217. doi:10.1111/adb.12405. PMC 5085894. PMID 27126842.
  10. ^ Kim B, Im HI (2020). "Chronic nicotine impairs sparse motor learning via striatal fast-spiking parvalbumin interneurons". Addiction Biology. Early View (3): e12956. doi:10.1111/adb.12956. PMC 8243919. PMID 32767546.
  11. ^ Berna F, Misdrahi D, Boyer L, Aouizerate B, Brunel L, Capdevielle D, et al. (December 2015). "Akathisia: prevalence and risk factors in a community-dwelling sample of patients with schizophrenia. Results from the FACE-SZ dataset". Schizophrenia Research. 169 (1–3): 255–261. doi:10.1016/j.schres.2015.10.040. PMID 26589388. S2CID 26752064.
  12. ^ Salem H, Nagpal C, Pigott T, Teixeira AL (15 June 2017). "Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges". Current Neuropharmacology. 15 (5): 789–798. doi:10.2174/1570159X14666161208153644. PMC 5771055. PMID 27928948.
  13. ^ Isbister GK, Calver LA, Page CB, Stokes B, Bryant JL, Downes MA (October 2010). "Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study". Annals of Emergency Medicine. 56 (4): 392–401.e1. doi:10.1016/j.annemergmed.2010.05.037. PMID 20868907.
  14. ^ Ostinelli EG, Brooke-Powney MJ, Li X, Adams CE (July 2017). "Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation)". The Cochrane Database of Systematic Reviews. 2017 (7): CD009377. doi:10.1002/14651858.CD009377.pub3. PMC 6483410. PMID 28758203.
  15. ^ Huang CL, Hwang TJ, Chen YH, Huang GH, Hsieh MH, Chen HH, Hwu HG (May 2015). "Intramuscular olanzapine versus intramuscular haloperidol plus lorazepam for the treatment of acute schizophrenia with agitation: An open-label, randomized controlled trial". Journal of the Formosan Medical Association = Taiwan Yi Zhi. 114 (5): 438–45. doi:10.1016/j.jfma.2015.01.018. PMID 25791540.
  16. ^ Citrome L, Brook S, Warrington L, Loebel A, Mandel FS (October 2004). "Ziprasidone versus haloperidol for the treatment of agitation". Annals of Emergency Medicine. 44 (4): S22. doi:10.1016/j.annemergmed.2004.07.073.
  17. ^ Cañas F (March 2007). "Management of agitation in the acute psychotic patient--efficacy without excessive sedation". European Neuropsychopharmacology. 17 (Suppl 2): S108-14. doi:10.1016/j.euroneuro.2007.02.004. PMID 17336765. S2CID 14534413.
  18. ^ Gillies D, Sampson S, Beck A, Rathbone J (April 2013). "Benzodiazepines for psychosis-induced aggression or agitation". The Cochrane Database of Systematic Reviews. 4 (4): CD003079. doi:10.1002/14651858.CD003079.pub3. hdl:10454/16512. PMID 23633309.
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