irritability (impatience, hyperexcitability)

Etiology: 1) mood disorders a) bipolar disorder b) depression in the elderly c) seasonal affective disorder 2) personality disorder a) antisocial personality b) borderline personality c) passive aggressive personality 3) anxiety disorder 4) hyperactive attention disorder 5) menopause 6) premenstrual syndrome 7) hyperthyroidism 8) vitamin deficiency a) vitamin B12 deficiency b) niacin deficiency c) riboflavin deficiency 9) substance abuse & substance withdrawal a) alcohol b) nicotine c) controlled substances 10) dementia & parkinsonism 11) frontal lobe syndrome 12 post-concussion syndrome 13) pharmaceutical agents a) glucocorticoids b) androgens c) theophylline 14) sleep disorders & sleep deprivation 15) metabolic abnormalities a) hypercalcemia b) acidemia c) hypoglycemia Clinical manifestations: 1) symptoms of hyperadrenergic state may be associated with hyperthyroidism, substance abuse or withdrawal syndromes a) tachycardia b) tachypnea c) hypertension 2) cheilosis & glossitis suggest niacin or riboflavin deficiency 3) signs of head trauma suggest post-concussion disorder 4) loss of vibratory sensation, proprioception & touch suggest vitamin B12 deficiency 5) manifestations of dementia or parkinsonism many be present Laboratory: 1) serum chemistries a) electrolytes b) glucose c) calcium d) magnesium 2) complete blood count (CBC) 3) thyroid function tests 4) vitamin B12 in serum 5) urine toxicology Management: 1) mini mental status exam (MMSE) 2) therapy directed at underlying etiology

Related

bipolar affective disorder dementia; Alzheimer's disease & related dementias (ADRD) Folstein Mini-Mental Status Examination (MMSE) hypercalcemia hyperthyroidism hypoglycemia mood disorder nicotinic acid (niacin, vitamin B3, Niaspan) parkinsonism post concussion syndrome riboflavin (vitamin B2) sleep disorder vitamin B12; cobalamin

References

Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1090-92