Agitation

Definition
Inappropriately excessive, restless, physical activity, usually accompanied by an unpleasant mood of anxiety or excitement, tension and irritability. Akathisia is a more specific term for an unpleasant sense of inner restlessness, in which the person may feel unable to sit or remain still.
Increasingly severe agitation can lead to hostility, suspiciousness and aggression, confusion and over-activity. When combined with alteration of the level of awareness or consciousness, it is called Delirium. The person may be more talkative, and uselessly active (pacing, wringing their hands). The condition may range from feeling fidgety and uneasy, to becoming overwhelmingly frightened and over-active.

Other names
Akathisia, restlessness.

Possible causes
Anxiety, depression, stress. Excessive caffeine intake. Withdrawal from substances of dependence such as alcohol, tobacco, cocaine, opiates, caffeine. Hyperthyroidism (over-active thyroid). Hypomania - the manic phase or "high" of a bipolar disorder. Infection of almost any type in an elderly person, severe infection in anyone. Pain, fever, stress, whatever they may be caused by, can all increase the degree of agitation. It can be a side-effect of some medications, including some anti-psychotic drugs, when it might be called akathisia. Some people feel agitated while taking some antidepressants.

Homecare/self-treatment
When someone in the family is becoming agitated and confused, they need a calm, quiet setting, reassurance that they are in no danger, and encouragement to rest or even sleep. Usually they are helped by the presence of a calm and soothing person (agitation usually gets worse when the people around become alarmed and agitated themselves). Try to find a safe place, and to remove items with which the person might be able to harm themselves or others. Be cautious about restraining an agitated person, as this may make them more alarmed.

When to see a doctor
When agitation is prolonged, severe or inexplicable, and the individual is unable to control the frenetic movement and restlessness. A doctor must be seen, especially if there are other unexplained symptoms present.

What to expect at the doctor
A careful and full history would be taken and a careful physical examination would be done. X-rays and blood tests might be needed.

Treatment
This will depend on the cause. A doctor may prefer to avoid using major sedatives early on, as this may make it more difficult to examine the person properly, or to get a proper history from them. An anti-psychotic drug which may calm the person without putting them to sleep may then be preferable to a highly sedative tranquilliser. Sedatives can also at times make an agitated person more confused. The selection of the best drug needs skill and experience.