Psychomotor agitation (PMA) is an intense state of physical and mental restlessness, irritability, and activity. It pictures someone unable to sit still in a meeting or constantly tapping their feet. Or someone waiting in a room, walking back and forth, or wriggling in the chair. This all does not happen out of boredom, but because their bodies can’t be still.
During the PMA period, individuals are unable to remain calm. They make purposeless, unintentional, and repetitive movements, which occur as a reaction to heightened anxiety. Moreover, they experience changes in cognitive function and mental tension. The signs of PMA can change in severity and require professional support. So, let’s understand the psychomotor agitation, its symptoms, potential causes, and how to treat it.
What is Psychomotor Agitation and Retardation?
We can define psychomotor agitation as a complex interplay between cognitive processes, sensory perceptions, emotional states, and behaviors. Your physical and cognitive functions work simultaneously, whether you are playing music or driving a vehicle. Moreover, the term “psychomotor” means how your mental processes influence physical movements. When the process runs smoothly, you do not notice anything unusual. However, there are noticeable behavior changes when there are disruptions in cognitive performance. These abnormalities in cognitive function may affect your motor activity, speech, and body movement. An increase in motor activity is agitation, and a decrease is retardation.
PMA is not a mental health condition but a symptom of some mental and physical conditions. For example, it is often seen simultaneously with anxiety and bipolar disorder. It displays through different behaviors, such as rapid speech or an anxious walk in the room. Aggressive PMA is challenging and requires professional support and interventions. It is necessary to ensure the safety of both the patients with agitated psychomotor activity and the people around them.
Psychomotor Agitation Vs Retardation
Agitation and retardation are two opposing movement dysregulation poles. Agitation is an increase in activity, as discussed earlier. Retardation means significantly slowed motor activity. In retardation, an individual moves, speaks, reacts, and thinks more slowly. Moreover, the eye movements and facial expressions can also become slow.
Psychomotor Retardation Signs include
- Walking or changing position slowly, such as getting out of bed.
- Unable to perform tasks that demand eye-hand coordination, such as applying makeup, playing football, etc.
- React slowly to situations around.
- Low ability to do motor tasks such as tying laces or writing.
- Wrong or poor posture.
- Speaking very slowly, softly, to communicate with long pauses.
- Avoiding eye contact and staring into another space during a discussion.
Psychomotor Agitation Symptoms
An individual with PMA can experience the following signs:
- Restlessness and inability to sit still
- As if their body is stiff
- Inability to relieve motor tension
- Desperation to find a comfortable position
- Excessive anxiety
- Racing thoughts
- Exasperation
- Irritability
- Tearfulness
These feelings cause the following behaviors:
- Pacing around a room
- Wringing their hands
- Tapping their fingers or feet
- Fidgeting
- Starting and stopping tasks abruptly
- Talking very quickly
- Biting their lips
- Pulling the skin off around their nails
- Chewing the inside of their cheek
- Moving objects around for no reason
- Taking off clothes, then putting them back on
Moreover, these behaviors are repetitive, fast, and unintentional. These are a response to strong inner distress without any clear goal.
Causes of Psychomotor Agitation
There is a vibrant link between movement and mood. Some motor activities are due to the subconscious mind’s attempt to clear stress. Most commonly, PMA is observed in individuals with bipolar disorder and anxiety disorder.
However, some other conditions can also be the cause that affects mental health or neurological processes. For example, major depressive disorder, obsessive-compulsive disorder (OCD), Alzheimer’s disease, and Parkinson’s disease can also cause agitation. One more cause of aggression and agitation can be traumatic brain injury (TBI). Moreover, antipsychotic medications can cause PMA as a side effect.
Let’s explain some of these mental health conditions related to agitation in detail.
Mental Health Conditions Related to Agitation
Bipolar Disorder
Bipolar disorder, previously known as a manic-depressive disorder, is characterized by dramatic shifts in mood, energy, and activity level. Unlike depression alone, bipolar disorder involves alternating periods of emotional highs (mania or hypomania) and lows (depression). Agitation can appear during either phase.
During Mania or Hypermania
In manic episodes, psychomotor agitation often accompanies racing thoughts or what’s known as a “flight of ideas.” Thoughts can come so quickly and intensely that the body struggles to keep up, resulting in constant movement, excessive pacing, or other restless behaviors.
People experiencing mania may also display pressured speech, nonstop talking that can seem disorganized because thoughts are arriving faster than words can be expressed.
During Depressive Episodes
Although depression is commonly associated with low energy and slowed behavior, agitation can also occur. Individuals may feel intensely restless and unable to concentrate. They can feel trapped in cycles of negative thinking. Persistent rumination, feelings of hopelessness, irritability, frustration, and changes in brain chemistry can all contribute to motor agitation during depressive phases.
Anxiety Disorder
The symptoms of generalized anxiety disorder (GAD) are feeling constantly “on edge” or unable to relax. This heightened state of tension often leads to excessive movement and restlessness.
People experiencing panic attacks may also appear agitated. However, panic attacks and agitation are not the same. Panic attacks are typically sudden, intense bursts of fear that last for a relatively short period, whereas PMA can persist longer and often serves as an attempt to release accumulated tension.
Post-Traumatic Stress Disorder (PTSD)
For individuals living with PTSD, agitation can result from hyperarousal. It is a state of heightened alertness where the body remains constantly prepared for danger.
Agitation may become especially noticeable during flashbacks or when encountering trauma-related triggers. During these moments, people often feel hypervigilant, tense, and unable to relax. Sleep disturbances, which are common in PTSD, can further increase agitation.
Major Depressive Disorder
PMA is recognized as one of the possible symptoms of a major depressive episode.
While some individuals with depression experience psychomotor retardation, slowed speech, movement, and reactions, others experience the opposite. Emotional distress may manifest as constant restlessness, pacing, or difficulty remaining still. Co-occurring anxiety, insomnia, and neurotransmitter imbalances can all contribute to this form of agitation.
Obsessive-Compulsive Disorder (OCD)
In obsessive-compulsive disorder, agitation can intensify the distress already caused by intrusive thoughts and compulsive behaviors.
The restless energy often fuels repetitive rituals and compulsions performed in an attempt to reduce anxiety. As a result, individuals may spend increased amounts of time pacing, fidgeting, or engaging in seemingly purposeless movements while trying to manage their obsessions. Over time, this can significantly interfere with daily life, work, and social relationships.
Schizophrenia
PMA is a common symptom observed during acute psychotic episodes in schizophrenia.
Individuals may pace repeatedly, rock back and forth, or engage in other repetitive movements for extended periods. Both environmental factors and internal experiences, such as hallucinations or delusions, can contribute to increased agitation and restlessness.
Alzheimer’s Disease and Other Forms of Dementia
Dementia is an umbrella term for a group of symptoms that affect memory, thinking, reasoning, and daily functioning. Alzheimer’s disease is the most common cause of dementia and results from progressive damage to brain cells.
Agitation is one of the most frequently observed behavioral symptoms in dementia, ranking behind apathy and depression. Research suggests that agitation affects approximately:
- 30% to 50% of people with Alzheimer’s disease
- Around 30% of those with dementia with Lewy bodies
- About 40% of individuals with frontotemporal dementia
- Roughly 40% of those with vascular dementia
Overall, agitation affects nearly one-third of people living with dementia and can significantly impact quality of life for both patients and caregivers.
Stress
Not all psychomotor agitation is linked to a mental health disorder. Sometimes, it can be triggered by highly stressful life events.
When neither fighting nor fleeing is a realistic option, the body may respond with heightened motor activity as part of the stress response. Temporary pacing, restlessness, or fidgeting can be normal reactions to overwhelming situations.
In most cases, stress-related agitation does not require medical treatment and resolves as the stressful situation improves. However, if it becomes persistent or begins interfering with daily functioning, professional support may be beneficial.
Substance Use Disorders
PMA is also commonly associated with substance use and dependence.
Both intoxication and withdrawal can trigger significant restlessness and agitation. Alcohol misuse and various forms of drug dependence have been linked to increased motor activity. In some cases, particularly with opioid dependence, individuals may experience what is known as “agitated depression,” where symptoms of depression and heightened restlessness occur simultaneously.
Medication-Induced (Iatrogenic) Causes
Sometimes, agitation can be a side effect of medical treatment rather than a symptom of an underlying condition.
A neurological side effect known as akathisia can cause intense feelings of inner restlessness and an overwhelming urge to move. This reaction has been associated with certain medications, including:
- Antipsychotic medications
- Some antidepressants
- Calcium channel blockers
- Certain medications used to treat vertigo
Not everyone experiences akathisia, but understanding the possibility beforehand is important. Patients should discuss potential side effects with their healthcare provider so they know what symptoms to watch for and how to respond if they occur.
Attention/Deficit Hyperactivity Disorder
ADHD psychomotor agitation is intense inner restlessness that is shown as repetitive and unintentional movements. For example, rapid speech, walking around in the room, or fidgeting. Moreover, it usually starts from nervous energy or understimulation.
When to Seek Professional Support?
Seek professional support from a specialized psychiatrist as soon as PMA begins to interfere with your safety, sleep, and daily functioning. Early intervention is significant to recognize the severe signs and how to treat them.
How to Treat Psychomotor Agitation
Symptoms of PMA are commonly associated with mental health conditions. These are depression, bipolar disorder, schizophrenia, and certain neurological disorders. While medication can be helpful in some cases, behavioral therapies play a vital role in managing signs of agitation and improving overall well-being.
The following are the most effective treatment therapies for PMA.
Cognitive Behavioral Therapy (CBT)
One of the most effective behavioral approaches for managing psychomotor agitation is Cognitive Behavioral Therapy (CBT). It helps individuals identify the thoughts, beliefs, and emotional triggers that contribute to feelings of restlessness and distress. People experiencing agitation often become trapped in cycles of worry, fear, or negative thinking that intensify their symptoms.
Through CBT, individuals learn to recognize these patterns and replace them with more balanced and constructive thoughts. Therapists also teach coping strategies such as problem-solving, stress management, and self-monitoring techniques. By addressing the underlying cognitive factors that fuel agitation, CBT can help reduce emotional distress and improve self-control.
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) is another valuable treatment option, particularly for individuals who experience intense emotions alongside psychomotor agitation. DBT combines cognitive-behavioral techniques with mindfulness practices to help people manage emotional responses more effectively.
A key component of DBT is distress tolerance, which teaches individuals how to cope with overwhelming emotions without engaging in impulsive or agitated behaviors. DBT also emphasizes emotion regulation skills, helping people identify emotional triggers and respond in healthier ways. Mindfulness exercises used in DBT encourage present-moment awareness, which can reduce feelings of tension and physical restlessness.
Mindfulness-Based Therapy
Mindfulness-based therapy encourages individuals to focus on the present moment without judgment. Techniques such as mindful breathing, body scans, and guided meditation can help calm the nervous system and reduce excessive physical activity. Regular mindfulness practice has been shown to improve emotional regulation and decrease symptoms of anxiety and stress, which are often linked to agitation.
Relaxation Training
Relaxation training is another important component of behavioral treatment. Your therapist will teach you some techniques, such as progressive muscle relaxation, deep breathing exercises, and visualization, which can help lower physiological arousal. These methods teach individuals how to recognize the early signs of agitation and respond with calming strategies before symptoms escalate. Consistent practice can lead to long-term improvements in stress management and emotional stability.
Behavioral Activation
Behavioral activation is particularly beneficial when psychomotor agitation occurs alongside depression. This therapy involves engaging in meaningful and structured activities that provide a sense of purpose and accomplishment. By creating a balanced daily routine and participating in enjoyable tasks, individuals can redirect excess energy into productive behaviors and reduce feelings of internal tension.
Reduce Signs of Psychomotor Agitation at Brainpower Wellness Institute
At Brainpower Wellness Institute, we have a team of professional and licensed mental health care specialists. If you or any of your loved ones is struggling with psychomotor agitation due to any mental health condition, then you are at the right place. We have experts who understand all major mental health disorders symptoms and offer comprehensive treatment options. This way, you can change your negative behaviors to positive ones and improve your overall well-being. You can book both in-person and telepsychiatry consultations.
Conclusion
Psychomotor agitation is a response to stress and anxiety. It can also happen due to any mental health condition. In severe conditions, it can impact your daily life, and it is recommended to seek professional help. Treating agitation is possible with the proper and timely treatment. Successful treatment often involves a combination of behavioral techniques tailored to the individual’s needs. While progress may take time, consistent participation in therapy can significantly reduce symptoms and improve quality of life. By learning practical skills for managing stress, regulating emotions, and responding to triggers, individuals with psychomotor agitation can develop greater self-control and experience a greater sense of calm and stability in their daily lives.
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