For its management , experts agreed in considering  verbal de-escalation  and  environmental modification techniques  as first choice , considering physical restraint as a last resort strategy .
BACKGROUND Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry .
Current recommendations on agitation in psychiatry are not univocal .
Actually , an improper assessment and management may result in unnecessary coercive or sedative treatments .
A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions .
Aripiprazole effects in patients with acute schizophrenia experiencing higher or lower agitation: a post hoc analysis of 4 randomized, placebo-controlled clinical trials.
OBJECTIVE Patients with acute schizophrenia who are agitated typically manifest worse overall symptomatology and are generally more challenging to treat than nonagitated patients . In order to determine whether baseline agitation level influences treatment response , the effects of oral aripiprazole in acute patients with schizophrenia experiencing either higher or lower levels of agitation were examined . METHOD A post hoc analysis of pooled data from the first 4 or 6 weeks of 4 r and omized , double-blind , placebo-controlled aripiprazole trials was conducted . Patients with a DSM-IV diagnosis of acute schizophrenia r and omly assigned to treatment with either aripiprazole 10 , 15 , 20 , or 30 mg/day ( N = 790 ) or placebo ( N = 397 ) were divided into groups experiencing higher or lower agitation at baseline . Higher agitation was defined as a baseline Positive and Negative Syndrome Scale (PANSS)-Excited Component ( PEC ) score of > or = 14 and a score of > or = 4 on at least 1 PEC item ( excitement , hostility , tension , uncooperativeness , or poor impulse control ) . Analysis of covariance was used to evaluate PANSS total , Clinical Global Impressions-Improvement scale ( CGI-I ) , and PEC scores between aripiprazole and placebo within the higher and lower agitation groups . RESULTS In both the higher and lower agitation groups , aripiprazole treatment produced significantly lower PANSS total , CGI-I , and PEC scores at weeks 2 to 6 , compared with placebo ( p < .05 for each measure ) . Percentage of concomitant benzodiazepine use was similar at end point for aripiprazole and placebo , and adverse events were generally mild across groups . CONCLUSIONS Aripiprazole significantly improved the core symptoms of acute schizophrenia regardless of baseline agitation level . In particular , agitation symptoms were significantly decreased in patients with higher baseline agitation . Improvements appeared to be independent of benzodiazepine use or excessive sedation effects . These results suggest that oral aripiprazole is an effective and safe treatment option for patients with acute schizophrenia who manifest agitation symptoms
For its management , experts agreed in considering  verbal de-escalation  and  environmental modification techniques  as first choice , considering physical restraint as a last resort strategy .
BACKGROUND Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry .
Current recommendations on agitation in psychiatry are not univocal .
Actually , an improper assessment and management may result in unnecessary coercive or sedative treatments .
A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions .