1. The Four Main Types of Agitation Symptoms

Agitation presents itself through a range of signs that can be grouped into the following four primary categories.

1.1. Behavioural & Motor Symptoms

This category, known as psychomotor agitation, covers the physical ways internal mental tension and anxiety are expressed through body movement and actions.

• Constant Movement: An inability to stay still, which may look like incessant walking or aimless pacing around a room.
• Repetitive Movements: Purposeless, repeated actions such as wringing the hands, rubbing the hands together, tapping fingers, or shaking a leg.
• Physical Restlessness: Engaging in small, repeated motions as an outlet for tension, such as pulling at one’s hair, fidgeting with clothing, or nail-biting.
• Aggression and Violence: Actions that can be directed at objects or people, including hitting things, breaking items, making verbal threats, or physical assault.
• Inability to Cooperate: Resistance to help or guidance, such as refusing to participate in a medical examination or rejecting communication with healthcare staff.

1.2. Verbal & Vocal Symptoms

This category focuses on how agitation can be heard in a person’s speech patterns, volume, and tone of voice.

• Fast and Loud Speech: Speaking at a rapid pace and an increased volume, often becoming uncontrolled as the intensity of thoughts increases.
• Argumentative and Hostile Tone: A tendency to become easily angered or to engage in constant arguments with others.
• Repetitive Questioning: Persistently asking the same question or bringing up the same topic over and over.
• Inappropriate Speech: Using language that is incoherent, irrelevant to the situation, or out of context.

1.3. Emotional & Cognitive Symptoms

This category describes the internal feelings and thought processes associated with agitation, which are often the root cause of the external behaviours.

• Intense Anxiety and Tension: An overwhelming sense of worry, impatience, anxiety, and inner strain.
• Feeling of Losing Control: A distressing sense of being overwhelmed and a fear of not being able to manage one’s own thoughts or emotions.
• Flight of Ideas: A rapid, racing flow of thoughts that causes a person to jump from one topic to another, which is especially common during manic episodes.
• Decreased Attention Span: A significant and noticeable difficulty with focusing or concentrating on a task or conversation.
• Paranoia and Hallucinations: A potential break from reality, which may include delusions (false beliefs) or hallucinations (seeing or hearing things that aren’t there), particularly in cases involving psychosis.

1.4. Physical Symptoms

This category covers the involuntary physical reactions the body has when it is in a state of high arousal and stress.

• Rapid Heartbeat and Breathing: A noticeable increase in heart rate (tachycardia) and a faster pace of breathing.
• Sweating and Trembling: Experiencing excessive sweating or a visible tremor or shaking, often in the hands or throughout the body.
• Muscle Tension: A feeling of intense tightness and strain in the muscles throughout the body.
• Sleep Problems: Difficulty falling asleep or a significantly reduced need for sleep.

To help consolidate this information, the following table provides an at-a-glance summary of these four symptom categories.