# Irritability or Anger - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - no medicine is given for this in primary care - Irritability or Anger - disease-level clinical article (irritability-or-anger-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Assessment & Advice) ## Complete treatment card ```text IRRITABILITY OR ANGER 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 Review status: REVIEWED against No dose - no medicine is given for this in primary care, Irritability or Anger - disease-level clinical article (irritability-or-anger-clinical.txt) (2026-08) 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 Source StatPearls "Agitation" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (ASSESSMENT & ADVICE) [1st line] Adult 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 Peds Children follow the same pathway: assessment, explanation and follow-up. No primary-care medicine is implied. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)