What is Psychomotor Agitation?

Psychomotor agitation (PMA) occurs when a person has increased movement related to an underlying health disorder. Typically, mood disorders such as bipolar disorder bring on PMA, but the condition can also exist in people with central nervous system diseases.

This article discusses the symptoms, causes, and treatment options for people with PMA.

What are the Symptoms of Psychomotor Agitation?

There are many early signs and symptoms of PMA. They can be broken into three categories: behavioral, cognitive, and physical.

As PMA worsens over time, the symptoms can become more severe and include:

• Hostility
• Hyperresponsiveness
• Racing thoughts
• Constant nervous movements like pacing or toe-tapping
• Rapid or loud speaking
• Angry outbursts
• Verbal ranting
• Violent outbursts or responses
• Paranoia
• Verbal and physical aggression
• Decreased attention span
• Incoherence
• Prolonged eye contact
• Tense and angry facial expressions
• A willingness to invade others’ personal space
• Impulsive suicidal ideation or behavior

What Causes Psychomotor Agitation?

There are several health disorders associated with PMA. They can be psychological or neurodegenerative. The two most notable ones are schizophrenia and bipolar disorder. That said, other psychological disorders can lead to PMA, such as:

• Substance use disorder
• Major depressive disorder
• Anxiety
• Claustrophobia
• Post-traumatic stress disorder (PTSD)
• Akathisia, which is a syndrome characterized by constant movement and the inability to sit, stand, or lie still
• Attention deficit hyperactivity disorder (ADHD)

Neurodegenerative diseases that have been documented alongside PMA include:

• Alzheimer's disease
• Parkinson’s disease
• Dementia

Traumatic brain injuries (TBIs) may also bring on PMA in some people.

How Is Psychomotor Agitation Diagnosed?

Diagnosing PMA involves several steps. The first is ensuring the person suspected of having PMA is safe from harming themselves or others. Since the condition can cause a person to self-harm or attempt suicide, this step is important. 

Next, a medical provider will evaluate a person to determine risk factors and symptoms. Many rating scales have been developed that can be used to determine if a person has PMA or not. Each observatory scale is performed over minutes, hours, or even days, and the checklists have items that focus on:

• Symptoms present
• The severity of the symptoms
• Other symptoms that may not be directly related but could help determine an underlying cause

The rating scales that can be used to diagnose PMA include:

• Agitation severity scale (ASS)
• Aggressive behavior scale
• Agitated behavior scale
• Brief agitation measure (BAM)
• Brief agitation rating scale (BARS)
• Broset violence checklist (BVC)
• Clinical global impression scale for aggression (CGI-A)
• Cohen-Mansfield agitation inventory (CMAI)
• Historical, clinical, and risk management -20 violence risk assessment scheme (HCR-20)
• Neurobehavioral rating scale-revised (NRS-R)
• Overt agitation severity scale (OASS)
• Positive and negative syndrome scale-excited component (PANSS-EC)
• McNiel-Binder violence screening checklist (VSC)
• Pittsburgh agitation scale (PAS)
• Ryden aggression scale
• State-trait anger expression inventory (STAXI)
• Staff observation scale (SOAS)

The tests used most often are the PANSS-EC, CGI-A, and the BARS. They are used together to determine several levels of behavior and symptoms of PMA in people with signs of the disorder.

Along with the diagnostic tests above, medical testing may also be done. It can involve:

• Recording vital signs
• Examining blood sugar and blood oxygen levels
• Checking the function of the liver and kidneys

A toxicology test to check for any substances will be performed, alongside other tests if necessary, such as an X-ray, a lumbar puncture (spinal tap), or an electrocardiogram, which measures heart activity.

How Is Psychomotor Agitation Treated?

Treatment and management of PMA revolve around the severity of the disorder. In emergency settings, medical providers aim to implement certain behavioral control strategies to help those with PMA during an episode that may result in violent or hostile behaviors. Control strategies include:

• De-escalating situations with verbal intervention, offering food or beverages, or allowing people to smoke if it will help calm them
• Providing physical comfort to a person with PMA and minimizing external stimulation
• Removing all objects that could bring harm while maintaining a level of respect for the person with PMA

For long-term management, the underlying cause must be addressed.

Mood Disorders

If a mood disorder is causing PMA, medications to treat it will be taken. Some effective pharmacological )drug) options include:

• First-generation antipsychotics, such as Haldol (haloperidol) and Thorazine (chlorpromazine)
• Second-generation antipsychotics, such as Zyprexa (olanzapine) and Abilify (aripiprazole)
• Benzodiazepines, such as Ativan (lorazepam) and Valium (diazepam)
• Anticonvulsant medications such as Topamax (topiramate) and Belviq (valproate)
• Mood-stabilizing drugs such as Curatil (carbamazepine) and lithium

If PMA is caused by mood disorder medication, medical providers will change the person's drug to something that won't cause PMA but still offers symptom relief.

Those with substance use disorder will be treated for that first, which may clear up the symptoms of PMA. Someone with a TBI will have to rest and heal for their symptoms to disappear.

Neurodegenerative Disorders

Neurodegenerative diseases are progressive and worsen over time. Because of that, treatment is designed to slow down the disease and improve symptoms. For people with PMA and neurodegenerative disease, treatment may involve dopamine precursors such as Sinemet (levodopa) and dopamine agonists such as Mirapex (pramipexole).

Summary

PMA is a disorder that involves involuntary movement or behaviors. It is typically seen in people with schizophrenia and bipolar disorder but can also occur because of neurodegenerative diseases, other mood disorders, and traumatic brain injurues. A person with PMA can experience a wide array of symptoms, including hallucinations, hostility and violent speech or behavior, and suicidal ideation.

The diagnostic process for PMA is lengthy because the disorder can develop in the presence of many different health disorders. Getting an accurate diagnosis is imperative to proper treatment because each disorder that can cause PMA may need unique treatment. Once treatment has begun, the symptoms may subside, but depending on the cause, PMA may be permanent and strictly managed with effective therapies.