2.0 Identifying the Agitated Patient: A Multi-faceted Symptom Profile

Early and accurate recognition of agitation is critical for de-escalation and timely intervention. The symptoms are not confined to a single domain; they manifest across behavioral, verbal, cognitive, and physical dimensions, requiring holistic observation from all members of the healthcare team.

Recognizing the Symptom Profile

Behavioral and Motor Symptoms (Psychomotor Agitation): The physical manifestations of internal turmoil are often the most visible signs of agitation. These include:

• Constant and aimless movement, such as pacing or an inability to sit still.
• Repetitive, purposeless actions like hand-wringing, rubbing hands together, or tapping fingers.
• Aggression directed toward objects and the potential for violence.
• A lack of cooperation with care, including resistance to examination or treatment.
• Actions aimed at relieving tension, such as hair-pulling or picking at clothes.

Verbal and Vocal Symptoms: Changes in a patient’s communication patterns are a key indicator of escalating agitation. Observable signs include:

• Rapid and loud speech that may be difficult to interrupt.
• An argumentative, hostile, or threatening tone.
• Repetitive questioning, often fixating on a single topic or demand.
• Incoherent or contextually inappropriate speech.

Emotional and Cognitive Symptoms: Agitation is rooted in a state of profound internal distress that disrupts a patient’s thoughts and feelings. These symptoms include:

• Intense anxiety, impatience, and palpable tension.
• A stated or perceived loss of control over one’s emotions or thoughts.
• Flight of ideas, where thoughts race and jump rapidly between topics, particularly in manic states.
• Paranoia or hallucinations, which may be present in cases of psychosis.
• A significantly diminished attention span and difficulty concentrating.

Physical Symptoms: The body’s physiological response to a high-arousal state provides objective clues to agitation. These include:

• Tachycardia (rapid heart rate) and rapid breathing.
• Excessive sweating and trembling in the hands or body.
• Visible muscle tension throughout the body.
• Significant sleep disturbances, such as difficulty falling asleep or a decreased need for sleep.

The presentation of these symptom clusters is not arbitrary; they are direct manifestations of the underlying etiology, which must be systematically investigated to guide appropriate treatment.