Back

Psychomotor Agitation

What Is It, Causes, Diagnosis, and More

Author: Lily Guo

Editors: Alyssa Haag, Emily Miao, PharmD

Illustrator: Jessica Reynolds, MS

Copyeditor: David G. Walker

What is psychomotor agitation?

Psychomotor agitation refers to a state of restlessness and anxiety that leads to unintentional, repetitive movements. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a resource commonly used by health professionals to diagnose mental disorders, defines agitation as “excessive motor activity associated with a feeling of inner mental tension.” The excessive motor activity causes the individual to engage in characteristic activities, such as pacing, fidgeting, hand wringing, and pulling at their clothes. Psychomotor agitation is associated with various psychiatric and medical illnesses and is not defined as its own disorder in the DSM-5.

What causes psychomotor agitation?

Psychomotor agitation is a symptom of various psychiatric conditions including bipolar disorder, various mood disorders, and major depressive disorder. Bipolar disorder is characterized by manic and depressive episodes that result in atypical shifts in mood, energy levels, and ability to concentrate or carry out daily activities. During a manic episode the individual may experience psychomotor agitation, racing thoughts, and flight of ideas (i.e., when an individual has rapid speech that jumps between ideas and thoughts). During a depressive episode, psychomotor agitation is likewise present and can fuel emotions of anxiety and helplessness. Other psychiatric conditions associated with psychomotor agitation include anxiety disorder, claustrophobia, and post-traumatic stress disorder (PTSD). 

Another possible cause of psychomotor agitation is substance use, specifically nicotine, alcohol, psychoactive drugs (e.g., stimulants, depressants, opioids), hallucinogens, and marijuana (i.e., cannabis). Psychomotor agitation can also be caused by antipsychotic medications (e.g., aripiprazole, clozapine, olanzapine). If antipsychotics cause psychomotor agitation in an individual being treated for bipolar disorder, the healthcare professional may consider discontinuing or switching their medication. Degenerative brain diseases, such as dementia or Parkinson disease, can result in psychomotor agitation as a result of neuronal atrophy. Lastly, traumatic brain injury can also cause psychomotor agitation. 

What are the signs of psychomotor agitation?

Psychomotor agitation can cause a variety of signs, including restlessness, or an inability to sit still; dashing around without purposeful movement; pacing; tapping of one’s fingers; and abruptly starting and stopping tasks. Someone with psychomotor agitation may also talk very quickly, move objects around for no reason, and fidget with their clothes. Those who are severely affected by psychomotor agitation may cause bodily harm to themselves, including biting their lips until they bleed, ripping skin off from around their lips, pulling skin off from around their nails, or chewing the inside of their cheek. These symptoms are due to underlying feelings of anxiousness and can ultimately cause someone to feel exasperated, irritable, and frustrated. These feelings may cause some individuals to act violently towards themself or towards others. 

How is psychomotor agitation diagnosed and treated?

Psychomotor agitation is diagnosed based on a thorough patient interview and a physical examination. Clinicians, including mental health professionals, may ask an individual to describe the symptoms they are experiencing. They may ask questions about time of symptom onset, things that worsen or alleviate symptoms, and history of substance use. During the physical examination, the clinician will observe for signs of excessive movement, rapid speech, and other signs of agitation. The DSM-5 lists psychomotor agitation as a symptom associated with various psychiatric disorders, and therefore requires further evaluation to diagnose the specific associated condition. 

The first step for treatment and management of psychomotor agitation is to minimize anxiety for the individual and reduce the risk for escalation to aggression and violence that may be directed towards themselves or others. Long-term treatment of psychomotor agitation relies on treating the underlying cause of the symptoms. If the symptoms are related to a mental health condition, particularly anxiety disorders, cognitive therapy (i.e., talk therapy) with a mental health professional can be beneficial. The mental health professional can also offer self-help techniques, such as exercise, yoga, meditation, breathing exercises, music therapy, and avoidance of any emotional triggers. Medications can be prescribed for the treatment of bipolar disorder. Anticonvulsants (e.g., topiramate, valproate, or lamotrigine) or mood-stabilizing drugs (e.g., carbamazepine, lithium carbonate) may be especially helpful during a manic phase of bipolar disorder, and atypical antipsychotics (e.g., aripiprazole and olanzapine) can often help when agitation occurs during a depressive episode. Medications should be prescribed with caution, as in some cases, the medications used to stabilize moods during depression can cause extreme anxiety and, rarely, suicidal thoughts. Anti-anxiety medications, such as benzodiazepines, may be prescribed to help manage generalized anxiety. If the psychomotor agitation is due to an underlying illness such as Parkinson disease, dopamine precursors (e.g., levodopa) and dopamine agonists (e.g., pramipexole) may be prescribed. Those with psychomotor agitation as a result of substance abuse may need to be stabilized and treated for substance abuse or overdose. For example, in the case of psychomotor agitation from amphetamine overdose, intravenous benzodiazepines can be administered. It is also advised that the individual discontinue the substance. Treating psychomotor agitation associated with traumatic brain injury can range from rest and over-the-counter pain relievers to decompressive surgery. 

What are the most important facts to know about psychomotor agitation?

Psychomotor agitation refers to a state of restlessness and anxiety that results in repetitive and unintentional movements. It is a common sign in people with bipolar disorder, which is a psychiatric condition characterized by fluctuating manic and depressive episodes. When an individual experiences psychomotor agitation, they may pace around the room, pull at their clothes, wring their hands, fidget, and speak quickly. In addition to bipolar disorder, psychomotor agitation can be seen in those with degenerative brain disorders, PTSD, and substance use disorders. Diagnosis of psychomotor agitation relies on a thorough patient interview and physical exam. Treatment depends on the cause of the symptoms and can involve talk therapy and/or medications. 

Watch related videos: