Richa Bhatia, MD, FAPA Child and Adolescent Psychiatrist Quincy, Massachusetts
Disclosure The author reports no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
Depression. In children and adolescents, depression can manifest as anger or irritability, and occasionally as agitation.
Medical causes
Delirium. Refractory agitation is often a manifestation of delirium in children and adolescents.15 If unrecognized and untreated, delirium can be fatal.16 Therefore, it is imperative that clinicians routinely assess for delirium in any patient who presents with agitation.
Because a patient with delirium often presents with agitation and visual or auditory hallucinations, the medical team may tend to assume these symptoms are secondary to a psychiatric disorder. In this case, the role of the consultation-liaison psychiatrist is critical for guiding the medical team, particularly to continue a thorough exploration of underlying causes while avoiding polypharmacy. Noise, bright lights, frequent changes in nursing staff or caregivers, anticholinergic or benzodiazepine medications, and frequent changes in schedules should be avoided to prevent delirium from occurring or getting worse.17 A multidisciplinary team approach is key in identifying the underlying cause and managing delirium in pediatric patients.
Traumatic brain injury. Agitation may be a presenting symptom in youth with traumatic brain injury (TBI).18 Agitation may present often in the acute recovery phase.19 There is limited evidence on the efficacy and safety of pharmacotherapy for agitation in pediatric patients with TBI.18
Autoimmune conditions. In a study of 27 patients with anti-N-methyl-d-aspartate receptor encephalitis, Mohammad et al20 found that agitation was a common symptom.
