Sometimes when mental distress is great, as can occur with significant anxiety, depression, or mania, a person responds with a condition called psychomotor agitation. This can take many forms, but is often easily seen. The person might keep repeating an activity that is useless: wringing their hands, stamping their feet, flailing their legs, constantly pacing a room, or starting and stopping any form of activity over and over again. It is as if these movements are an attempt to address the underlying emotional distress, but they do not help, which can only increase the agitation.
One of the conditions most commonly associated with these movements is a form of depression called agitated depression. The main feature of this condition may be the inability to stop moving any part of the body, although related features are that the person may suffer from recurrent and obsessive thoughts. Similarly, many believe that psychomotor agitation may be present in the hypomanic or manic phase of bipolar disorder.
Some medications can contribute to this condition. Many medications, including many of the newer atypical antipsychotics, can cause akathisia, or internal restlessness, as a symptom. It is not a jump when the internal becomes external, and a person shows it through many physical expressions. These can be not only difficult to bear, but harmful to the person who might, for example, repeatedly scratch the skin until it bleeds. A hypomanic or manic response to the wrong medications could also lead to this agitated behavior and is a strong argument for bipolar screening in people thought to have depression.
Another group of people who may experience psychomotor agitation are those in various stages of dementia or delirium. In fact, in general, this symptom is much more common in older adults and presents a higher risk for people with limited mobility problems or who do not understand the risks of any action taken. Special safeguards must be put in place to help those who display this condition and who also cannot recognize a danger to themselves.
Various treatments can be proposed to address this symptom. In depression, anxiety, or mood disorders, appropriate medication for the underlying condition can greatly reduce symptoms or resolve them completely. Helping an elderly person is much more complex.
Many of the drugs recommended to treat this illness belong to the antipsychotic drug class, and some of these have recently been found to greatly increase the risk of death among older people. Other medications that do not have this risk can be tried, but a combination of non-pharmacological therapies could accompany it. A full assessment of physical health, physical needs, and emotional health and needs is suggested when this form of agitation occurs, and may also be helpful in relieving some of the restlessness of the mind.