3.0 Understanding the Root Causes: A Diagnostic Framework for Agitation

Agitation is a symptom, not a diagnosis. Effective management requires moving beyond simply controlling the behavior to identifying and treating its underlying etiology. Failure to identify the underlying etiology will result in mistargeted interventions and is a primary driver of adverse patient outcomes. The potential causes of agitation can be categorized into three primary groups.

Psychiatric Disorders: Agitation is a common presenting symptom in many mental health conditions, particularly in acute psychiatric settings.

• Bipolar Disorder, especially during manic or mixed episodes.
• Schizophrenia and other psychotic disorders, often driven by paranoia or hallucinations.
• Major Depressive Disorder, specifically the agitated subtype where deep sadness coexists with restlessness.
• Anxiety Disorders, including Panic Disorder and Generalized Anxiety Disorder.
• Post-Traumatic Stress Disorder (PTSD), as a symptom of hyperarousal.
• Personality Disorders, notably Borderline and Antisocial types, linked to impulsivity and poor anger management.

Medical and Neurological Conditions: Many organic conditions can disrupt brain function and manifest as agitation.

• Delirium, an acute state of confusion often caused by infection, metabolic imbalance, or medication side effects.
• Dementia, including Alzheimer’s disease, where progressive cognitive decline leads to restlessness.
• Central Nervous System (CNS) diseases, such as head trauma, encephalitis, brain tumors, or Parkinson’s disease.
• Metabolic disturbances, including hypoglycemia (low blood sugar) and thyroid disorders.

Substance-Related Causes: The use of or withdrawal from certain substances is a frequent cause of severe agitation.

• Substance intoxication: Particularly from stimulants or in cases of medication overdose.
• Withdrawal syndromes: Especially from substances like alcohol.

This diagnostic framework is the foundation upon which a safe and effective tiered management protocol is built.