What should you know about agitation and irritability?

Agitation often feels like inner tension or an urge to move, while irritability is a lower threshold for frustration or anger. A sudden change from the person's usual behaviour is more concerning than a familiar, brief reaction to a clear stressor.

Missed sleep, pain, fever, dehydration, hunger, low blood glucose, excess caffeine, alcohol, recreational drugs, and withdrawal can change behaviour. Agitation may also occur during anxiety, depression, burnout, or periods of unusually elevated mood. In an older adult or someone who is physically unwell, abrupt confusion and agitation can reflect delirium and requires prompt medical assessment.

Timing offers useful clues: note a new prescription, dose change, stopped substance, missed meals, sleep loss, or recent infection. The symptom by itself does not establish one diagnosis.

Reduce noise and crowding, speak slowly, give the person physical space, and offer water and food if they are awake and can swallow safely. Avoid confrontation, driving, alcohol, recreational drugs, and extra doses of sedating medicine. If diabetes or glucose-lowering treatment is involved, follow the person's established low-glucose plan and check glucose when equipment is available.

For recurring symptoms, track sleep, meals, caffeine, stress, menstrual or hormonal changes, medicines, and the effect on relationships or work. Regular meals, a consistent sleep routine, and planned quiet breaks can help while the cause is assessed.

Call emergency services if the person may harm themselves or someone else, has a seizure, is severely confused, cannot be roused normally, has new weakness or speech difficulty, or becomes agitated after a head injury. Do not restrain them unless needed to prevent immediate harm; move other people and dangerous objects away if this can be done safely.

Obtain same-day advice for sudden unexplained behaviour change, hallucinations, fever with confusion, suspected low blood glucose that does not improve with the usual plan, or agitation following a medication change. Book a routine review when irritability keeps returning or damages sleep, work, or relationships.

Discuss whether physical examination or blood tests are appropriate, which medicines or substances might contribute, and whether the mood and sleep pattern suggests anxiety, depression, insomnia, or another problem. Ask for a written plan describing early warning signs, de-escalation steps, and whom to contact if behaviour worsens.