Dawaa Reference

chronic

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.