The Pathophysiology of Agitation

Agitation is a nonspecific constellation of relatively unrelated behaviors that can be seen in anumber of different clinical conditions, usually presenting a fluctuating course. Multiple underlyingpathophysiologic abnormalities are mediated by dysregulations of dopaminergic, serotonergic, noradrenergic,and GABAergic systems. Pathophysiologic mechanisms of agitation that operate in thedifferent clinical disorders where agitation occurs are discussed. These pathophysiologic abnormalitiesare not associated with distinct clinical features. Although there may be a final common pathway,there is no unifying etiologic pathophysiology. The author suggests that the clinician address the underlyingpathophysiology through a treatment intervention that addresses the overarching psychiatricdisorder. Generally, agents that reduce dopaminergic or noradrenergic tone or increase serotonergic orGABAergic tone will attenuate agitation, often irrespective of etiology.