A reader recently contacted me and asked me about psychomotor agitation. Psychomotor agitation is actually a symptom of bipolar hypomania and bipolar mania (and depression) and yet few people know what this means. In fact, according to this study, it is poorly defined and measured even within the medical community. Psychomotor agitation is often translated into “restlessness,” which doesn’t seem overly descriptive to me.
So here’s my take on psychomotor agitation: how it feels and what we know about it.
Definition of Psychomotor Agitation
. . . a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions.
I would not consider this to be the best definition, however. While unintentional and purposeless motion may come as a result of psychomotor agitation, they, alone, do not define the condition.
A slightly better definition comes from Reference.MD:
A feeling of restlessness associated with increased motor activity. This may occur as a manifestation of nervous system drug toxicity or other conditions.
In other words psychomotor agitation is the feeling of restlessness (and inner tension) associated with muscle activity.
However, this is contradicted by one study in which psychomotor agitation was considered present if:
. . . fidgeting, pacing, handwringing, and/or other purposeless movements were evident nearly every day for at least a 2-week period leading up to the assessment. PMA [psychomotor agitation]-related behaviors had to be noticed by others and/or directly observable during the interview.
So in this case, the inner feelings seem not to be taken into account.
(Psychomotor agitation, by the way, has been correlated with substance abuse as well as bipolar disorder. Additionally, some feel that psychomotor agitation with depression is a key marker of a depressive mixed state.)
The Problem with Psychomotor Agitation
Certainly the repetitive, unintentional, purposeless movements associated with this condition are an issue, but what I think bothers people most is the inner feeling associated with it. It’s the drive to make the purposeless movements that makes this symptom intolerable. It’s the inner feeling of restlessness, tension and anxiety that really makes people hate this symptom.
It’s very difficult to describe tension that is so extreme that it forces movement, but this is what happens. It’s more than bugs crawling under your skin that you wish to scratch out with your fingernails. It’s like under-skin crawling bugs that are so agitating that they require arm flailing in an (unsuccessful) attempt to rid yourself of the feeling.
Treating Psychomotor Agitation
As far as I can tell, there are no generally used treatments for psychomotor agitation unless the situation is very severe or an emergency – such as in the case where the patient endangers themselves or others with their movements. In these cases, opinions vary on what to do but non-pharmacological interventions seem preferred.
If I had to advise someone on what to do about psychomotor agitation what I would suggest is the same kind of techniques that are advised for anxiety such as yoga, meditation and other relaxation techniques. But that’s just me.
What I suspect is more common is that psychomotor agitation is reduced when the medication for bipolar disorder (or depression) takes effect.