Psychomotor agitation (PA) is a common symptom among patients with bipolar disorder (BD). PA may occur without any obvious cause or it may be associated with other symptoms such as mania, hypomania, depression, anxiety, psychosis and psychotic features. There are different types of psychomotor agitation including:
1. Restlessness – this type of PA occurs when there is no clear reason for the patient’s restlessness and it lasts only briefly and then disappears completely.
2. Irritability – this type of PA occurs when there is a specific trigger for the patient’s irritability.
For example, if someone makes rude remarks during conversation, then the patient will become agitated and start shouting back at them.
3. Delusions – this type of PA occurs when a person believes something that does not exist or cannot be true.
For example, a person may believe that they have been abducted by aliens or that their spouse has left them.
4. Hallucinations – this type of PA occurs when the patient experiences hallucinations which are usually visual but sometimes auditory and/or olfactory.
These hallucinations may include voices, images, smells and tastes.
5. Aggressive Behavior – this type of PA occurs when the patient behaves aggressively towards others; for instance, hitting another person or even threatening suicide.
6. Unpredictable behavior – this type of PA occurs when the patient’s behavior seems to be completely random.
The patient may have periods of calmness as well as periods of agitated behavior.
7. Racing Thoughts – this type of PA occurs when the patient experiences a lot of racing thoughts and images that are difficult to control or get rid of.
These racing thoughts and images can include both suicidal and homicidal thoughts.
8. Impulsivity – this type of PA occurs when the patient acts on sudden whims or urges.
Common examples include excessive shopping, sexual promiscuity, gambling or binge eating.
9. Poor attention span – this type of PA occurs when the patient finds it difficult to focus their attention on any one particular activity for any length of time.
This might involve difficulty reading a newspaper or watching a TV program or even following a conversation.
10. Sleep deprivation – this type of PA occurs when the patient has difficulty getting to sleep or suffers from frequent waking during the night.
Stages of Psychomotor Agitation
1. Salient symptoms: These are the most obvious symptoms of psychomotor agitation and include any of the following such as: racing thoughts, impulsive behavior, increased physical activity, restlessness, anxiety, panic attacks, paranoia, insomnia and irritability.
2. Mood: The patient will most likely be in an anxious, hostile or depressed mood.
3. Other signs: Other signs of psychomotor agitation may include heavy perspiration, lack of concentration and time distortion (difficulty concentrating on a topic or performing a task; feeling like time is passing very slowly).
Patients with psychomotor agitation are at greater risk of engaging in risky behavior such as unsafe sexual practices, drunk driving, binge eating and binge spending.
Treatments for Psychomotor Agitation
There are several possible treatments for patients suffering from psychomotor agitation. The treatment that will have the greatest effect on the patient will depend on what is causing the condition.
1. Treat underlying cause – if the cause of psychomotor agitation is a mental health disorder such as depression or bipolar, this should be treated with drugs and/or therapy.
2. Haldol (initial dose of 1mg) or Risperdal (1-4mg) – if the condition is caused by an underlying medical condition such as delirium or dementia, or if the agitation is due to drug or alcohol abuse.
3. Other drugs that can be used to treat psychomotor agitation include: Xanax (0.
5mg – 1mg), Klonipin (0.5mg – 2mg), Ativan (1mg) and Valium (2mg).
4. Chlorpromazine (50mg – 100mg), although not used as frequently, can also be used to treat psychomotor agitation.
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