Psychomotor agitation (PMA) is marked by periods of intense restlessness and irritability. But it can be managed.

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Psychomotor agitation (PMA) is often associated with mood disorders like bipolar disorder. A person with PMA has internal tension that may cause a great deal of distress, intense restlessness, and irritability.

Medical professionals can treat PMA through verbal de-escalation and helping the person regain their sense of control. Someone living with PMA can help prevent its onset by treating any underlying conditions and using stress reduction techniques.

Psychomotor agitation is physical activity marked by signs of restlessness, like pacing, handwringing, and pulling at clothing. This state is the result of mental tension. In addition to physical symptoms, someone experiencing PMA may express:

  • hostility
  • poor impulse control
  • uncooperativeness
  • violent behavior

Researchers often have difficulty finding a comprehensive definition for PMA that helps medical personnel and loved ones to recognize and assist someone experiencing an episode.

A 2016 meeting of experts on agitation from Latin America and Europe found consensus on four critical behavioral attributes to help identify PMA early:

  • inability to stay calm
  • hyperactivity and hyperresponsiveness, both verbal and motor
  • emotional tension
  • trouble communicating

These attributes are just a few of the potential signs of PMA. Your experience may include several physical and mental symptoms.

Most people experience feelings of restlessness or lack of focus from time to time. But someone experiencing PMA has more severe effects that often cause them intense distress and discomfort.

Symptoms of PMA can range from mild to severe. They can include changes in how you move, think, and how your body functions.

Behavioral symptoms

Behavioral symptoms of PMA include:

  • trouble staying calm or quiet
  • inability to sit still
  • acting combative
  • hyperreactivity to stimuli
  • exaggerated gesturing
  • silence or unwillingness to talk
  • raised tone of voice
  • inappropriate behavior
  • angry facial expression
  • defiant visual contact
  • verbal or physical aggression toward self or others

Cognitive symptoms

Symptoms of PMA that affect thinking include:

  • disorientation
  • frustration
  • delusions
  • hallucinations
  • difficulty anticipating consequences
  • changes in levels of consciousness

Functional symptoms

Functional symptoms of PMA include:

  • rapid breathing
  • rapid heart rate
  • fever
  • sweating
  • tremor
  • neurological symptoms like problems walking

You may never experience all of these symptoms. Often, psychomotor agitation starts with milder signs like pacing, handwringing, and emotional outbursts.

People living with mood disorders such as depression or bipolar disorder may experience PMA when treatments, like medication, are not working well enough. Stress or trauma may also bring on psychomotor agitation.

PMA is associated with several conditions. These cover a variety of experiences, including psychiatric diagnoses and substance use. Psychomotor agitation may coincide with:

Therefore, PMA is linked to:

  • psychological diagnoses
  • diseases of the central nervous system
  • substance use

Although it may be possible to predict some events that may lead to PMA, like stress or trauma, researchers don’t know precisely why some people experience psychomotor agitation. They hypothesize it may have many potential causes.

People with bipolar disorder may experience PMA in a depressive or manic period. The common signs of being in these states can also include symptoms of PMA:

  • Depressive. Someone experiencing a depressive episode may feel restless or have trouble concentrating.
  • Manic. Someone experiencing a manic episode may feel jumpy, irritable, talk rapidly, or engage in unsafe behaviors.

Someone with bipolar disorder or depression can experience severe internal distress from PMA. The internal tension can be grating and intense, and although people may feel compelled to move, this internal feeling may not go away with movement.

Agitation, or feeling “wired,” can also be a side effect of antipsychotic medications. Some people with bipolar take these medications to treat the condition. The uncontrollable movement is sometimes mistaken to be a symptom of bipolar disorder instead of a medication side effect.

Tardive dyskinesia (TD), or repetitive involuntary movements, is another potential side effect of antipsychotics that may be mistaken for a symptom of bipolar disorder.

PMA is best treated by managing the underlying condition. If you live with a mood disorder such as bipolar disorder, that may mean developing and following a treatment plan with a mental health professional.

Loved ones and medical professionals often use two approaches to help someone experiencing PMA as the result of a mood disorder:

  • verbal de-excalation
  • fast-acting medication

In clinical settings, PMA management generally starts with noninvasive and noncoercive measures. This means the treatment team doesn’t use medication, threats, or force to try and calm the situation.

Verbal de-escalation

During this process, a trained professional tries to create an alliance with the person experiencing OMA.

They help restore the person’s sense of control, often through calm and slow speech. They may also offer them options, like food, a quiet space, or medication.

Medical teams work together to provide the person with an environment of physical comfort and minimal external stimuli. This allows the person experiencing PMA to be an active participant in their care.

Still, if verbal de-escalation doesn’t work to calm the person, medication and physical restraint are sometimes used in a clinical setting.

Fast-acting medication

Some medications, such as benzodiazepines, can help quickly calm someone who cannot communicate because of severe agitation. But these medications may fail to work after repeated use, so they are given only in extreme cases.

Self-help techniques

Someone living with a mood disorder can also take steps to reduce mild agitation before it escalates. These are some ongoing techniques you can practice that may help you to keep your sense of control:

  • exercising, like taking a walk
  • practicing deep breathing or meditation
  • relaxing in a quiet, dark room
  • keeping a journal
  • minimizing conflict

PMA is often a treatable state, especially if de-escalation begins early when symptoms are mild or moderate.

Psychomotor agitation is a state that people may experience for a variety of reasons.

Those living with a mood disorder or medical condition can often prevent psychomotor agitation by treating the underlying diagnosis.

Self-help strategies including exercise, relaxation in a quiet room, and journaling can all help people to manage their mild symptoms to stay in control.

If you or a loved one is experiencing PMA, it’s advisable to reach out to a healthcare professional. Together you can devise a treatment plan tailored to your unique needs.