Agitation: What to do about morbid restlessness?

Agitation (also: agitation) is understood to mean a state of inner excitement that manifests itself through an insatiable urge to move. Agitation states can appear as a symptom of various mental illnesses or 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 in a state of agitation a medical treatment may be necessary. Here's how to identify agitation and what you can do about it.

Characteristic feature of agitation is the excessive need for movement. Agitated persons usually run restlessly up and down and are not able to sit still. In addition, they often show uncontrolled, aimless movements such as fidgeting, constantly plucking at one's own clothes or casually handling objects. In psychology, these behaviors are summarized by the term "augmented psychomotor."

Immense urge to move as an indication

The patients themselves usually experience a strong inner tension and restlessness in an agitation state. However, unlike people who are generally nervous or feel stressed in a stressful situation, agitated individuals are unable to suppress the urge to move.

Often, an increased irritability to aggressive behavior and uncontrolled outbursts added. In rare cases, even a temporary placement in a psychiatric clinic may be necessary to avoid endangering the person 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 in acute mental stress agitation can occur as a symptom.
  • Drug intake, alcohol abuse and alcohol or drug withdrawal can each cause agitation, especially if it comes to a dysregulation (delirium).
  • Organic diseases such as severe hyperthyroidism, epilepsy, metabolic imbalances (for example, in diabetes) or electrolytes, as well as an asthma attack or lack of oxygen can trigger an agitation state.
  • There may be evidence of attention deficit hyperactivity disorder (ADHD) if there are signs of agitation in children. An excessive urge to move is usually accompanied by severe concentration problems and a tendency to impulsive actions. If you notice these symptoms in pronounced form in your child, you should seek advice from a pediatrician or child psychologist.

Agitation as a side effect of drugs

Agitation may be a side effect with certain medications. Thus, when taking sedatives such as benzodiazepines or opioid analgesics such as morphine, a so-called paradox reaction can occur. It comes with the patient to a state of agitation, although the drug should actually have a calming effect.

Medicines for depression such as venlafaxine or lithium as well as cortisone-like drugs can also lead to agitation. This is especially the case when they are overdosed. Occasionally, agitation is also observed after surgery as a side effect of anesthesia.

Agitated depression

Agitated depression is a special form of depressive disorder because sometimes the symptoms are different from the typical signs of depression. While the patients in a classic depression usually complain of listlessness and show a slowing of the movements, the agitated depression is characterized by restlessness and drive. In addition, usually tormenting anxiety and strong inner restlessness.

In some cases this can lead to impulsive actions and thus to an increased risk of suicide. Therefore, it is important to correctly interpret the symptoms and initiate early psychotherapeutic treatment.

Provide peace and security

Compared to an agitated person, it is first of all important to keep calm and to radiate serenity. Signal that help is possible because for the patient his condition is usually most frightening. Create a calm situation and remove disturbing stimuli whenever possible. Under certain circumstances, it may be useful to ask other people from the room.

However, if the person is showing aggressive behavior and is thus a potential danger to themselves or others, you should not hesitate to call the rescue service. Because with a strong agitation, it may be necessary that the patient is treated with tranquillizers (benzodiazepines). In very severe cases, the emergency physician has to refer the patient to a psychiatric clinic in order to avert a personal or other endangerment.

However, even if the person concerned calms down and the agitation subsides, a state of agitation should always be clarified by a doctor or a psychotherapist to find out the underlying cause.

Increased risk of injury in dementia

It is particularly difficult to deal with agitation in demented persons. Because on the one hand, those affected by the limited mental ability, the situation usually can not capture, making a soothing conversation is difficult. On the other hand, there is an increased risk of injury and falling for the patient in such a state of rest, which also often occurs at night.

The treatment of agitation with tranquilizers also poses an increased risk in elderly persons with dementia, since these drugs additionally limit the motor and mental abilities. As a meaningful supplement to the drug therapy fragrance flavors and soothing music can be used.

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