Everything You Should Know About Psychomotor Agitation

Psychomotor agitation usually involves repetitive movements — such as toe-tapping or constant fidgeting — along with rapid, racing thoughts.

This symptom appears across a variety of mood-related conditions. People affected by psychomotor agitation perform purposeless actions, like pacing around a room, tapping their toes, or speaking quickly without pause.

Psychomotor agitation frequently accompanies mania or anxiety and is most commonly observed in individuals with bipolar disorder. It can also arise from other conditions, including posttraumatic stress disorder and depression.

Symptoms

Those experiencing psychomotor agitation struggle to remain still or calm. They use movement to discharge built-up tension and anxiety. If you have psychomotor agitation, you may habitually fidget, move rapidly, or act without any clear purpose.

The most typical indicators of psychomotor agitation include:

• emotional distress
• restlessness
• tapping
• abruptly starting and stopping tasks
• fidgeting
• pacing
• hand-wringing
• rapid speech
• racing thoughts
• overcrowded thinking
• moving items for no reason

People with psychomotor agitation may show a variety of behaviors, such as:

• walking back and forth in a room
• removing clothing and then putting it back on
• twisting their hands
• tapping their feet on the floor
• tapping fingers on surfaces
• picking up and relocating objects around a room without purpose

In more severe situations, psychomotor agitation can escalate to self-injury. Individuals might tear, chew, or pick at the skin around their lips, cuticles, or other areas until they bleed.

Causes

Psychomotor agitation is commonly seen in people with bipolar disorder but can also occur with other conditions, including:

• panic attacks
• anxiety disorders
• depression
• posttraumatic stress disorder
• traumatic brain injury (TBI)
• claustrophobia
• Parkinson’s disease
• alcohol withdrawal
• drug overdose or withdrawal
• dementia
• schizophrenia
• severe major depressive disorder
• side effects of certain antipsychotic medications
• substance misuse

Researchers have also identified a connection between akathisia and psychomotor agitation in people with TBI. Akathisia is a movement disorder characterized by inner restlessness.

Psychomotor agitation and bipolar disorder

Psychomotor agitation is a frequent feature of bipolar depression. It tends to appear most during manic episodes, though it can also be present during depressive phases. It’s commonly associated with noneuphoric hypomanic symptoms and suicidal ideation. Signs of noneuphoric hypomania may include:

• excessive crying
• difficulty sleeping
• racing thoughts
• trouble making decisions
• confusion
• irrational belief that someone intends to harm you
• inflated sense of self-importance
• hearing sounds or voices that aren’t present

Psychomotor manifestations vary depending on whether they occur during a manic episode, a mixed affective episode (both depression and mania), or a depressive episode. In mania, a person is more likely to move aimlessly — for instance, pacing, wringing their hands, or tapping fingers.

In mixed or depressive episodes, movements are often used to relieve tension and stress. The person may feel anxious, upset, irritable, and restless.

See a doctor

Contact your doctor as soon as you notice signs of psychomotor agitation. A medical professional can determine whether your symptoms stem from bipolar disorder or another mental health issue and help you choose an appropriate treatment approach.

You should also consult your doctor if your psychomotor agitation changes. Shifts in motor behavior may signal progression or alteration of the underlying condition.

Diagnosis

Your clinician will ask about your symptoms and review your medical history. They’ll likely perform a physical examination and order tests to rule out other causes of psychomotor agitation.

After reaching a diagnosis, you and your doctor can develop a treatment plan to address your symptoms.

Treatment

Treatment is based on the underlying cause. For example, if antidepressants or anti-anxiety medications are triggering psychomotor agitation, your doctor may adjust or change your prescriptions.

If psychomotor agitation is linked to manic or depressive episodes, mood stabilizers or antipsychotic medications may be prescribed. A 2013 study found that benzodiazepines, an anti-anxiety drug class, can help manage certain types of psychosis-related agitation.

You may also find relief through relaxation strategies commonly used for anxiety. Try these approaches:

• See a psychotherapist once or twice weekly.
• Practice yoga and meditation regularly.
• Exercise on most days.
• Use deep-breathing techniques.

Use these methods alongside any medication or treatments your doctor recommends. Managing psychomotor agitation solely with relaxation techniques can be challenging.

Outlook

With appropriate treatment, psychomotor agitation can be controlled. Notice the signs and symptoms and communicate them to your doctor to help secure an accurate diagnosis and effective treatment plan.