II. Symptomatology of Agitation
The signs of agitation are diverse and present across behavioral, verbal, emotional, and physical domains. The severity and type of symptoms can vary significantly based on the underlying cause, ranging from mild restlessness to acute, violent aggression.
- Behavioral and Motor Symptoms (Psychomotor Agitation)
Psychomotor agitation is the physical expression of internal mental tension and anxiety through aimless, repetitive, and restless movements.
| Symptom Category | Specific Manifestations |
| Constant Movement | Inability to sit still, incessant pacing, aimless wandering. |
| Repetitive Actions | Wringing hands, rubbing hands together, tapping fingers, leg shaking. |
| Physical Restlessness | Tension-reducing behaviors such as hair pulling, nail biting, or fidgeting with clothing. |
| Aggression & Violence | Hitting objects, breaking things, issuing verbal threats, or engaging in physical assault. |
| Non-Cooperation | Resisting medical examination or treatment, refusing to communicate with healthcare staff. |
- Verbal and Vocal Symptoms
Noticeable changes in speech patterns and vocal tone are common indicators of agitation.
- Rapid and Loud Speech: An accelerated and uncontrolled manner of speaking, often reflecting racing thoughts.
- Argumentative and Hostile Tone: A tendency to become easily angered and engage in constant disputes with staff or family.
- Repetitive Questioning: Persistently asking the same question or repeating the same topic.
- Inappropriate Speech: Making statements that are out of context, irrelevant, or incoherent.
- Emotional and Cognitive Symptoms
The internal state of an agitated individual is marked by significant emotional and cognitive disruption.
- Intense Anxiety and Tension: Overwhelming feelings of worry, anxiety, nervousness, and impatience.
- Feeling of Losing Control: A sense of being overwhelmed and an inability to control one’s emotions or thoughts.
- Racing Thoughts (Thought Flight): A rapid flow of thoughts, with an inability to focus, often jumping from one topic to another, particularly during manic episodes.
- Paranoia and Hallucinations: Distortions in the perception of reality, including delusions or hallucinations, which are common in psychotic states.
- Decreased Attention Span: A pronounced difficulty in focusing and maintaining concentration.
- Physical Symptoms
The state of high arousal associated with agitation triggers a range of physiological responses.
- Cardiovascular and Respiratory: Increased heart rate (tachycardia) and rapid breathing.
- Autonomic Nervous System: Excessive sweating and trembling in the hands or body.
- Musculoskeletal: Palpable and intense muscle tension throughout the body.
- Sleep: Significant difficulty falling asleep or a drastically reduced need for sleep.