Psychomotor agitation

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Psychomotor agitation
Other namesPacing
SpecialtyPsychiatry, emergency medicine

Psychomotor agitation is a

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

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

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

Treatment

A form of self-treatment arises in that many patients develop

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.

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

dopamine antagonists.[18]

See also

References

  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. 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. PMID 17365764
    .
  8. PMID 28600927
    .
  9. PMID 27126842
    .
  10. PMID 32767546
    .
  11. S2CID 26752064
    .
  12. PMID 27928948
    .
  13. PMID 20868907
    .
  14. PMID 28758203
    .
  15. PMID 25791540
    .
  16. doi:10.1016/j.annemergmed.2004.07.073
    .
  17. S2CID 14534413
    .
  18. PMID 23633309
    .
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