Psychomotor Agitation
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 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.
Signs and symptoms
People experiencing psychomotor agitation may feel or do:
- unable to sit still
- fidgeting
- as if their body is stiff
- 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 at small things
- anger
- agitation
- racing thoughts and incessant talking
- restlessness
- pacing
- hand-wringing
- nail-biting
- outbursts of complaining or shouting
- pulling at clothes or hair
- picking at skin
- pace around a room
- tap their fingers
- tap their feet
- start and stop tasks abruptly
- talk very quickly
- move objects around for no reason
- take off clothes then put them back on
Causes
Causes include:
- Schizophrenia
- Bipolar disorder
- Excited delirium
- Post-traumatic stress disorder (PTSD)
- Panic attacks
- Anxiety disorder
- Obsessive-compulsive disorder (OCD)
- Nicotine withdrawal
- Alcohol withdrawal
- Opioid Withdrawal
- Attention-deficit hyperactivity disorder (ADHD)
- Claustrophobia
- Dementia
- Parkinson's disease
- Traumatic brain injury
- Alzheimer's disease
- Acute intermittent porphyria
- Hereditary coproporphyria
- Variegate porphyria
- Side effects of drugs like cocaine or methylphenidate
- Side effects of antipsychotics like haloperidol
- Major depressive disorder
- Agitated depression
- SSRI or 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.
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. 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).
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.
Treatment
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. Also using promethazine may be useful. 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 (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.
Also, introducing the following lifestyle changes to their routine may help a person to reduce their anxiety levels:
- regular exercise
- yoga and meditation
- deep breathing exercises
See also
- Agitation (dementia)
- Akathisia
- Body-focused repetitive behavior
- Excited delirium