What is Psychomotor Agitation?
Psychomotor agitation is a syndrome characterized by increased motor activity combined with inner tension, manifesting as excessive, purposeless movement and restlessness that can escalate to aggression or violence. 1
Core Clinical Features
Psychomotor agitation represents abnormal psychic and motor activation with the following key characteristics:
- Excessive motor activity associated with a feeling of inner tension, as defined by DSM-IV 2
- Restlessness, irritability, and heightened responsiveness to both internal and external stimuli 3
- Purposeless movements that are increased beyond what is normally expected for the patient's age, sex, or time of day 1
Clinical Manifestations by Subtype
Hyperactive Presentation
The hyperactive form includes 1:
- Increased psychomotor activity with agitation and restlessness
- Increased flow of speech
- Enhanced startle reaction
- Behaviors that interfere with diagnosis and care, including threatening behaviors, escalating or urgently distressing behavior, or self-exhausting behavior 2
Hypoactive Presentation
The hypoactive form presents with 1:
- Reduced psychomotor activity with decreased movement
- Lethargy
- Decreased flow of speech
Mixed Presentation
Mixed forms demonstrate unpredictable, fluctuating features of both hyperactive and hypoactive patterns 1
Associated Clinical Contexts
Psychomotor agitation commonly occurs in several psychiatric and medical conditions:
- Delirium: Psychomotor disturbance is a cardinal feature, with agitation representing one of the key clinical manifestations alongside cognitive and perceptual disturbances 1
- Acute mania with psychotic features: Agitation and rapid speech are classic manic symptoms 4
- Schizophrenia: Acute agitation associated with schizophrenia represents a specific indication for pharmacological intervention 2
- Bipolar I disorder: Agitation during manic or mixed episodes is a common presentation requiring immediate management 2
Behavioral Markers
Observable behaviors that indicate psychomotor agitation include 1:
- Anxiety, fear, and emotional lability
- Calling out, screaming, or moaning
- Inability to sit still or remain calm
- Pacing or repetitive movements
- Threatening gestures or escalating behavior
Clinical Significance
Psychomotor agitation represents a psychiatric emergency requiring prompt recognition and intervention to ensure patient and staff safety 5, 6. The condition can stem from various organic conditions and mental disorders, making rapid differential diagnosis essential 5. Episodes can escalate to aggression or violence if not properly managed, necessitating immediate assessment and appropriate intervention strategies 6.
Measurement Considerations
The definition and measurement of psychomotor agitation has historically been problematic, with ambiguous and contradictory definitions over time 7. Current assessment focuses on observable motor activity changes, behavioral manifestations, and the patient's subjective experience of inner tension 1.