Dawaa Reference

Clinical reference

Irritability or Anger

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Agitation - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK493153/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) - condition scope only, no dose · No dose - no medicine is given for this in primary care

Verified against2 documents
  • No dose - no medicine is given for this in primary care
  • Irritability or Anger - disease-level clinical article (irritability-or-anger-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Certain symptoms flag urgent evaluation: memory loss, disorientation, severe headache, marked muscle stiffness or weakness, heat intolerance, unintended weight loss, new psychosis, or trouble breathing [confusion · headache · heat intolerance · memory loss · weight loss]
  • The acute picture is restlessness and an inability to stay calm, with paranoia, hostility, irritability, suspiciousness, confusion, disorientation and violence [confusion · delusions · irritability]
  • Inside there is hyperresponsiveness, racing thoughts and emotional tension; outside, motor and verbal overactivity and an inability to communicate
  • In dementia the main trigger of aggression is intimate care, with hallucinations and delusions next [delusions · hallucinations]

Signs — what you find (6)

  • Red-flag exam findings include abnormal vital signs, abnormal bedside glucose, visible trauma, unequal pupils, slurred speech, poor coordination, seizures, or one-sided weakness [one-sided weakness · seizures · slurred speech]
  • When a medical cause is suspected, exam looks for head trauma, slurred speech, unequal pupils, motor problems, seizures, disorientation, one-sided weakness, drowsiness, muscle rigidity, myoclonus, and brisk reflexes [confusion · drowsiness · hyperreflexia · one-sided weakness · seizures · slurred speech]
  • For suspected alcohol or drug involvement, exam checks for alcohol on the breath, injection track marks, hallucinations, and seizures [hallucinations · seizures]
  • Red flag: an agitated patient is a danger to themselves and to others, which makes agitation an emergency [irritability]
  • What DSM-5-TR describes is pacing, handwringing, and pulling or rubbing at the skin or clothing, along with disruptive motor or vocal activity
  • Aggression is the behavioural expression of severe agitation: hitting, kicking, pushing, throwing things, spitting, biting, cursing and screaming, with the potential to cause harm [irritability]

Tests (12)

  • Initial workup includes point-of-care glucose, oxygen saturation, and a urine toxicology screen
  • Suspected intoxication or withdrawal adds urine toxicology, blood alcohol level, and liver function tests
  • Suspected delirium calls for CBC, metabolic panel, urinalysis, urine toxicology, and head CT to find the underlying cause
  • Pregnancy testing is done for all women of reproductive age
  • Ammonia level is checked when hepatic encephalopathy is suspected
  • Creatine kinase screens for rhabdomyolysis, myopathy, and other muscle injury
  • TSH is checked to rule out hypothyroidism or hyperthyroidism as a cause
  • A lactate level is drawn to screen for sepsis
  • Acetaminophen and salicylate levels are checked when overdose is a concern
  • Urinalysis and culture screen for urinary tract infection or ketosis as a driver
  • Lumbar puncture is considered for suspected encephalitis, meningitis, neurosyphilis, or cerebritis
  • An ECG checks for QTc prolongation tied to overdose or underlying heart disease

If not this — what else fits (1)

  • Differentials fall into four broad buckets: physical illness/delirium, neurocognitive disorders, substance use/withdrawal, and psychiatric/developmental conditions

SourceStatPearls "Agitation" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (ASSESSMENT & ADVICE)

1st line
Adult dose and duration

A normal emotional state or behaviour reported by the patient, not itself a mental disorder; the GP explores triggers such as stress, poor sleep, substance use, or an underlying mood or anxiety disorder, and manages the cause rather than the symptom directly. - Assessment and advice

Paediatric dose

Children follow the same pathway: assessment, explanation and follow-up. No primary-care medicine is implied.

Dose source

No dose - no medicine is given for this in primary care

Why

A normal emotional state or behaviour reported by the patient, not itself a mental disorder; the GP explores triggers such as stress, poor sleep, substance use, or an underlying mood or anxiety disorder, and manages the cause rather than the symptom directly.

Cautions
  • RED FLAG - Expressed explicit intent or plans for domestic violence, assault, homicide, or self-harm: assess urgently and refer.
  • No medicine is prescribed for this in primary care. The value of the consultation is recognition, explanation and follow-up, and referral if the red flags above appear.
  • RED FLAG - Agitation/severe irritability requires prioritizing the diagnosis and treatment of acute underlying medical conditions while ensuring safety.
  • RED FLAG - Antipsychotic monotherapy should be avoided for agitation due to alcohol withdrawal as it can lead to delirium tremens.
  • RED FLAG - Irritability as part of a manic episode (elevated mood, decreased need for sleep, grandiosity) needing urgent psychiatric assessment.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.