Agitation is inner restlessness, irritability, or purposeless motor/verbal activity (pacing, fidgeting), while aggression is a focused behavior intended to cause harm, involving hitting, shouting, or destructive acts, often arising as an escalation of agitation but with intent. The key difference is intent and focus: agitation is often unintentional or undirected, stemming from distress, whereas aggression targets someone or something with the goal of inflicting harm, making aggression inherently riskier and requiring different management than non-harmful agitation.

Are agitation and aggression the same?

Agitation in psychosis is phenomenologically similar to that observed in dementia, and the same applies to aggression (e.g., hitting, kicking, pushing). However, agitation and aggression are two distinct syndromes. This should be recognized in drug development trials in both psychiatric and dementia patients.

What are examples of agitation?

Acute presentations of agitation can include restlessness, inability to stay calm, paranoia, suspiciousness, irritability, hostility, confusion, disorientation, inability to communicate, changes in vital signs, and violent behavior.

What are the three levels of agitation?

Prompt identification of agitation is the first step in preventing further escalation 1-3

• Severe. Aggressive or violent.
• Moderate. Physically or verbally. threatening, but not violent.
• Mild. Signs of overt physical or. verbal activity, but redirectable.

Is agitation and aggression a symptom of dementia?

In the later stages of dementia, some people with dementia will develop what's known as behavioural and psychological symptoms of dementia (BPSD). The symptoms of BPSD can include: increased agitation. aggression (shouting or screaming, verbal abuse, and sometimes physical abuse)

PACE - Agitation and Aggression

What is the best medication for agitation in dementia?

There's no single "best" medication for dementia agitation; options like SSRIs (sertraline, citalopram) and atypical antipsychotics (risperidone, olanzapine, brexpiprazole) are used, with brexpiprazole (Rexulti) being the first FDA-approved for Alzheimer's-related agitation, but they carry risks, so doctors often try non-drug approaches first, focusing on tailored treatment considering side effects and individual needs. 

What behaviors may indicate agitation?

Examples of behaviors and characteristics of agitation include:

• Being uncooperative.
• Clenching your fists or wringing your hands.
• Difficulty focusing.
• Excessive talking.
• Fidgeting (purposeless movements).
• Hostility.
• Inner restlessness.
• Lack of impulse control.

What is the first line treatment for agitation?

The proper management of an agitated patient is essential to keep staff safe and ensure appropriate treatment for the patient. Most emergency physicians think of agitation as one of the simplest cases to treat, with haloperidol being a common approach in many emergency departments.

What mental disorder is agitation?

Unlike depression and bipolar disorder, agitation isn't an illness on its own. Rather, it's typically a symptom of a mood disorder or another medical condition. In many cases, people develop agitation when treatment for their depression or bipolar disorder isn't working as well as it should.

What is the root cause of agitation?

Pain, stress, and fever can all increase agitation. Agitation by itself may not be a sign of a health problem. But if other symptoms occur, it can be a sign of disease. Agitation with a change in alertness (altered consciousness) can be a sign of delirium.

What is the 3 3 3 rule for anxiety?

The 3-3-3 rule for anxiety is a grounding technique that helps manage panic and overwhelming feelings by engaging your senses: name three things you see, identify three sounds you hear, and move three parts of your body, bringing focus to the present moment to interrupt racing thoughts and calm your nervous system. It's a simple, accessible mindfulness tool to regain control during acute anxiety.
 

What is the root of agitation?

1560s, "debate, discussion" (on the notion of "a mental tossing to and fro"), from French agitation, from Latin agitationem (nominative agitatio) "motion, agitation," noun of action from past-participle stem of agitare "move to and fro," frequentative of agere "to set in motion, drive forward; keep in movement" (from ...

What is the difference between being aggressive and being irritable?

Anger and irritability are hostile responses to a perceived provocation. The word 'irritability' tends to imply a relatively minor response on the part of the irritated person. It is likely to be expressed verbally and is usually not physically aggressive.

What are the four levels of agitation?

Total scores of 21 points or below are classified as normal behavior, 22–28 as mild agitation, 29–35 as moderate agitation, and 36–56 as severe agitation.

What is the new drug for agitation?

On May 11, 2023, the FDA granted approval for brexpiprazole for the treatment of agitation associated with dementia due to AD. This marked a significant milestone, as brexpiprazole became the first and only pharmacological treatment specifically approved for this indication in the United States.

How to help someone with agitation?

Tips for coping with agitation or aggression

1. Be patient and try not to show frustration. Speak calmly. ...
2. Create a comforting home setting. Try to keep to a routine, such as bathing, dressing, and eating at the same times each day. ...
3. Try focusing on an object or activity. ...
4. Protect yourself and others if needed.

What are the 4 agitated behaviors?

These ratings were averaged to form frequency and disruptiveness means for the four different types of agitation: physically aggressive behaviors, physically non-aggressive behaviors, verbally aggressive behaviors, and verbally non-aggressive behaviors (Table 1).

Which of the following are warning signs for potential agitation or aggression?

Raised voice. Aggressive body language/actions - pointing - clenched fists hitting things – throwing magazines, pens and other objects down in frustration. Words expressing threats - including swearing. Argumentative and belligerent - won't follow advice.

What is sundowning in dementia?

The term "sundowning" refers to a state of confusion that occurs in the late afternoon and lasts into the night. Sundowning can cause various behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning also can lead to pacing or wandering.

What is a common reason for agitation in a person with dementia?

They may be a symptom of the physical changes in the brain caused by dementia. A person may become agitated suddenly because of a change or specific cause, such as increased noise or not being able to do something they previously could.

What is the best mood stabilizer for dementia patients?

Antidepressants. Antidepressants such as sertraline, citalopram, mirtazapine and trazodone are widely prescribed for people with dementia who develop changes in mood and behaviour. There is some evidence that they may help to reduce agitation – particularly citalopram.

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