If you notice a loved one is starting to act manic or having outbursts of rage, it's important to observe and record the frequency and severity of the incidents. Notice what time the outbursts occur, keeping in mind that many older patients tend to experience agitation in the early evening as they grow tired. Early observation is important, since agitation and anxiety may indicate that it's time to move a loved one to a managed care facility.
Learn some of the basic signs and symptoms of agitation and anxiety so you can identify an outburst and record any mitigating factors. Signs of mild agitation may include pacing, nonsensical babbling and confusion, while more severe incidents may involve screaming, scratching and abusive language. Agitation may be an indication of an underlying medical or neurological condition such as Alzheimer's disease, bipolar disorder, obsessive-compulsive disorder and dementia. If outbursts continue, you should contact your doctor for evaluation and assessment.
Visit Your Doctor for an Initial Assessment
Visit a family doctor for a physical exam. Be prepared to answer questions about symptoms, the time of day outbursts occur and any triggers you may have observed. Your doctor will also want to know if your loved one has experienced any other changes in her health such as insomnia, listlessness, nausea or confusion. He may also request blood work, a spinal tap or a CAT scan to explore any suspicions he may have about underlying medical conditions.
Conduct a Clinical Observation to Assess Risk Factors
A series of different tests can assess the severity of agitation in patients. The Behavioral Activity Rating Scale, or BARS, measures agitation on a scale of 1 to 7, with the most severe rating being a person whose outbursts are so violent he requires restraint.
The Overt Agitation Severity Scale is very similar to the BARS test. This test takes about 15 minutes, during which a doctor observes what the patient says and how his body physically reacts to feelings of agitation. The Cohen Mansfield Agitation Inventory and the Agitated Behavioral Scale are two other testing options to consider. Be sure to go over all your options with your care provider, and discuss the results thoroughly to create a treatment plan and agitation management routine.
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