Irritability, often referred to as agitation, is a common occurrence in people with and without psychiatric problems. It is usually described as anger or intense annoyance by the person.
Those who spend time with and around the individual often describe the person as always annoyed, frustrated, or “pissed off.” The reality is that if left unchecked, chronic irritability can wreak havoc on your patients’ lives. Specifically, it can create a variety of interpersonal, occupational, social, financial and legal problems.
Irritability is a common symptom of posttraumatic stress disorder. Specifically, it is classified as a manifestation of dysfunctional arousal and reactivity. Behaviorally, your patients may present as restless, impulsive and even aggressive.
Emotionally, you may notice restricted affect, shifts between normal mood and anger and crying spells. Socially, your patients with high levels of irritability may be socially withdrawn, antagonistic with loved ones and strangers and dismissive of other’s feelings. Cognitively, they will be unfocused, easily distracted and report memory problems.
Depression is another possible cause of irritability. Over time, prolonged sadness, feelings of hopelessness and worthlessness and loss of pleasure in life take a toll on the depressed person.
Irritability can manifest differently in your depressed patients. For many men, irritability is often the first sign or symptom of depression. Women may be more likely to exhibit withdrawal and increased crying spells. Younger patients with irritability are more prone to aggressive and impulsive behavior because of inherent deficits in emotional regulation.
Older patients may struggle with insomnia, reduced appetite, and increased substance use.
Non-Psychiatric Causes
As noted above, there are a number of non-psychiatric causes for irritability. One of the more common ones is lack of sleep.
Adequate sleep provides a buffer against irritability. When a person does not get enough his or her ability to handle even small problems is greatly reduced. Instead of handling the problem with balance and thoughtfulness the person is more likely to snap at people and delay addressing the issue.
Excessive caffeine intake is also a culprit. Not only is caffeine a wake promoting agent, it stimulates the sympathetic nervous system. If excessive sympathetic nervous system stimulation occurs from excessive caffeine intake, a person will become irritable.
Other common precipitants of irritability include work and home stress and a host of physical illnesses to include hypothyroidism, diabetes, allergies and the flu.
The non-psychiatric cause of a person’s irritability will determine the treatment. Some treatments are more straightforward than others.
For example, in the case of sleep deprivation, the prescription is more sleep. This problem can be addressed through specific cognitive-behavioral therapies or over-the-counter and prescribed medications.
In cases of excessive caffeine, you can assist your client with cutting back or eliminating caffeine or in acute cases, instruct the patient to just wait until the chemical leaves their system (and avoid additional intake for a while).
If thyroid disease or diabetes runs in your patient’s family, it is important to recommend he/she receives a physical from their primary care provider. Until the disease process is under control, the irritability will not improve.
In the case of allergies, an over the counter antihistamine like Benadryl or Claritin may do the trick. However, in some people, antihistamines can actually worsen irritability. Similarly, a variety of medications can cause irritability.
Some examples include antidepressants and psychostimulants. If your irritable patient is taking a medication within either one of these classes you should consider referring them back to their psychiatric medication prescriber for evaluation.
Psychiatric Causes
The psychiatric causes of irritability are somewhat more difficult and trickier. In most cases, the underlying anxiety or depression needs to be treated before the irritability resides. But in some people, the irritability needs to be targeted specifically.
This targeting can be done with medication or talk therapy. Regarding the former, medications with anxiolytic properties (e.g. benzodiazepines) can prove beneficial. Certain blood pressure medications may also be helpful.
For example, the beta adrenergic blocker propranolol is commonly used to target irritability in patients with posttraumatic stress disorder. The benefits of the latter are likely obvious to you. Challenging a person’s negative thoughts can provide significant relief from irritability as can teaching the person calming strategies in order to manage intense feelings.
Regardless of the cause, if left untreated, irritability can be a destructive force and cause problems for your patient and his or her loved ones. Avoid the temptation to write off a patient’s irritability as due to situational stress or “personality.” Consider all possible causes that may be contributing to the condition.
Once identified, initiate treatment or refer to his or her health care provider for evaluation. If you do so, your patient will see an improvement in his or her underlying condition and overall improvement in quality of life.
* This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”