III. Etiology: The Underlying Causes of Agitation
Agitation is a symptom with a wide range of potential causes spanning psychiatric disorders, medical conditions, and substance-related issues. Identifying the correct underlying cause is critical for effective treatment.
- Psychiatric Disorders
Agitation is one of the most common presenting symptoms in psychiatric emergency services.
- Bipolar Disorder: Severe agitation can occur during manic or mixed episodes, driven by increased energy, restlessness, and impulsivity.
- Schizophrenia and Psychoses: Paranoid delusions, hallucinations, or thought disorders can lead to a state of extreme arousal and agitation.
- Major Depressive Disorder (Agitated Depression): A subtype of severe depression where the individual experiences profound sadness concurrently with restlessness, tension, and aimless motor activity.
- Anxiety Disorders: Conditions like Generalized Anxiety Disorder and Panic Disorder can cause excessive anxiety and tension that manifest as agitation.
- Post-Traumatic Stress Disorder (PTSD): Hyperarousal symptoms can include agitation.
- Personality Disorders: Impulsivity and poor anger management, particularly in borderline and antisocial personality disorders, can lead to frequent agitated episodes.
- Medical and Neurological Conditions (Organic Causes)
Many non-psychiatric conditions that affect brain function can trigger agitation.
- Delirium: An acute state of confusion with a sudden onset and fluctuating consciousness, often caused by infections, metabolic imbalances, or drug side effects. Delirium is one of the most common and severe causes of agitation.
- Dementia and Alzheimer’s Disease: The progressive loss of brain function can lead to restlessness and agitation, especially in later stages.
- Central Nervous System (CNS) Diseases: Conditions such as Parkinson’s disease, encephalitis, meningitis, head trauma, and brain tumors.
- Metabolic Disorders: Imbalances like hypoglycemia (low blood sugar), thyroid disorders, and kidney or liver failure.
- Substance Use and Withdrawal
- Intoxication: The use of stimulants or an overdose of certain drugs can cause severe agitation.
- Withdrawal Syndromes: The abrupt cessation of substances like alcohol can trigger withdrawal symptoms that typically include restlessness, tremors, and agitation.