A person exhibiting agitated behavior should receive a thorough medical evaluation, especially when agitation comes on suddenly. The treatment of agitation depends on a careful diagnosis, determination of the possible causes, and the types of agitated behavior the person is experiencing. With proper treatment and intervention, significant reduction or stabilization of the symptoms can often be achieved.
The symptoms of agitation often reflect an underlying infection or medical illness. The pain or discomfort caused by pneumonia or a urinary tract infection can result in agitation. An untreated ear or sinus infection can cause dizziness and pain that affects behaviors. In some cases, prescription medication can cause agitation. This is most likely to occur when multiple medications are used, and the medications interact. Uncorrected visual or hearing loss may also lead to agitated behaviors. Treating the underlying medical condition may lessen the agitation.
Behavioral interventions for agitation
There are two distinct types of treatments for agitation: behavioral interventions and prescription medications. Behavioral treatments should be tried first. In general, steps to managing agitation include (1) identifying the behavior, (2) understanding its cause, and (3) adapting the caregiving environment to remedy the situation.
Correctly identifying what has triggered agitated behavior can often help in selecting the best behavioral intervention. Often the trigger is some sort of change in the person's environment:
- Change in caregiver
- Change in living arrangements
- Travel
- Hospitalization
- Presence of houseguest
- Bathing
- Being asked to change clothing
A key principle of intervention is redirecting the affected individual's attention, rather than arguing, disagreeing, or being confrontational with the person. Additional intervention strategies include the following:
- Simplifying the environment
- Simplifying tasks and routines
- Allowing adequate rest between stimulating events
- Using labels to cue or remind the person
- Equipping doors and gates with safety locks
- Removing sharp objects and weapons
- Using lighting to reduce confusion and restlessness at night
Medications to treat agitation
Medications can be effective in the management of some symptoms of agitation, but they must be used carefully and are most effective when combined with behavioral or environmental changes. Medications should target specific symptoms so that improvement can be monitored. People with Alzheimer's disease are susceptible to side effects that require close observation. In general, it is best to begin treatment with a single medication and with low doses. Some of the medications commonly used to treat the symptoms of agitation included the following:
Antidepressant - medications for low mood and irritability
- Citalopram (Celexa®)
- Fluoxetine (Prozac®)
- Paroxetine (Paxil®)
- Sertraline (Zoloft®)
Anxiolytics - medications for anxiety, restlessness, verbally disruptive behavior and resistance
- Lorazepam (Ativan®)
- Oxazepam (Serax®)
Antipsychotic - medications for hallucinations, delusions, aggression, hostility, and uncooperativeness
- Olanzapine (Zyprexa®)
- Risperidone (Risperdal®)
Although antipsychotics are among the most frequently used medications for treating agitation, some physicians may prescribe an anticonvulsant/mood stabilizer, such as carbamazepine (Tegretol®) or divalproex (Depakote®) for hostility or aggression.
Sedative medications, which are used to treat insomnia or sleep problems, may cause incontinence, instability, falls, or increased agitation. These drugs must be used with caution, and caregivers need to be aware of these possible side effects.
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