Psychomotor agitation

Psychomotor agitation is a symptom in various disorders and health conditions, and is characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress.

Agitation is a common event characterized by a range of motor, emotional, behavioral, and ideational symptoms that can be associated with neurological, psychiatric, and general medical conditions.

The prevalence of agitation in emergency departments is greater than 2.5%. 

Agitation symptoms can range from mild uneasiness and restlessness to severe aggression and violence.

Individuals presenting with agitation require prompt medical attention to prevent escalation and injury to themselves and others.

 Management includes verbal and nonverbal de-escalation techniques and pharmacotherapy.

Typical presentations include:  pacing around, wringing of the hands, uncontrolled tongue movement, pulling off clothing and putting it back on.

More severe agitation may lead to  harm 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.

Psychomotor agitation can also be a result of an excess intake of stimulants, and severe hyponatremia. 

The middle-aged and the elderly are more at risk.

Causes include:


Bipolar disorder

Excited delirium

Post-traumatic stress disorder (PTSD)

Panic attacks

Anxiety disorder

Obsessive-compulsive disorder (OCD)

Nicotine withdrawal

Alcohol withdrawal

Opioid Withdrawal


Asperger syndrome


Intellectual disability

Attention deficit hyperactivity disorder


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 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

It is suggested these activities are the subconscious mind’s way of trying to relieve tension.

Recent studies found that nicotine withdrawal induces psychomotor agitation.

Pychomotor agitation can be caused by antipsychotic medications. 

Akathisia, a movement disorder sometimes induced by antipsychotics and other psychotropics, is estimated to affect 15-35% of patients with schizophrenia.


Forms of self-treatment include stimming, and self-medication.

Lifestyle changes, to help a person to reduce their anxiety levels:

Regular exercise

Yoga and meditation

Deep breathing exercises

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.

The goal of pharmacological treatment is to induce calm, without all the sedation.

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.

Three  atypical antipsychotics, olanzapine, aripiprazole and ziprasidone, are approved as an instant release intramuscular injection formulations to control acute agitation. 

The 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.

The atypicals have a dramatically improved tolerability due to a milder side-effect profile.

With psychosis causing agitation, benzodiazepines are commonly used in combination with antipsychotics since they can prevent side effects associated with dopamine antagonists.

Dexmedetomidine is alpha-2 adrenergic receptor agonist approved for  intravenous and sublingual treatment for sedation and anesthesia, reducing the symptoms of acute agitation associated with bipolar or disorder.

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