irritability (impatience, hyperexcitability)

Etiology

• mood disorders
  • bipolar disorder
  • depression in the elderly
  • seasonal affective disorder
• personality disorder
  • antisocial personality
  • borderline personality
  • passive aggressive personality
• anxiety disorder
• hyperactive attention disorder
• menopause
• premenstrual syndrome
• hyperthyroidism
• vitamin deficiency
  • vitamin B12 deficiency
  • niacin deficiency
  • riboflavin deficiency
• substance abuse & substance withdrawal
  • alcohol
  • nicotine
  • controlled substances
• dementia & parkinsonism
• frontal lobe syndrome 12 post-concussion syndrome
• pharmaceutical agents
  • glucocorticoids
  • androgens
  • theophylline
• sleep disorders & sleep deprivation
• metabolic abnormalities
  • hypercalcemia
  • acidemia
  • hypoglycemia

Clinical manifestations

• symptoms of hyperadrenergic state may be associated with hyperthyroidism, substance abuse or withdrawal syndromes
  • tachycardia
  • tachypnea
  • hypertension
• cheilosis & glossitis suggest niacin or riboflavin deficiency
• signs of head trauma suggest post-concussion disorder
• loss of vibratory sensation, proprioception & touch suggest vitamin B12 deficiency
• manifestations of dementia or parkinsonism many be present

Laboratory

• serum chemistries
  • electrolytes
  • glucose
  • calcium
  • magnesium
• complete blood count (CBC)
• thyroid function tests
• vitamin B12 in serum
• urine toxicology

Management

• mini mental status exam (MMSE)
• therapy directed at underlying etiology

More general terms

• sign/symptom

Additional terms

• 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