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 .
Intramuscular (IM) ziprasidone 20 mg is effective in reducing acute agitation associated with psychosis: a double-blind, randomized trial
Abstract Rationale : Intramuscular ( IM ) conventional antipsychotics and /or benzodiazepines are effective in the short-term treatment of acutely agitated psychotic patients but may be associated with adverse effects . A short-acting IM formulation of the novel antipsychotic , ziprasidone , which may offer advantages over conventional agents , has been developed . Objective : To compare ziprasidone IM 2 mg ( n=38 ) and 20 mg ( n=41 ) in the acute control and short-term management of agitated psychotic patients . Methods : A prospect i ve , r and omized , double-blind , 24-h study assessed efficacy using the  Behavioral Activity Rating Scale ( BARS ) and the PANSS . The BARS is a vali date d rating scale for the assessment of treatment response in acute agitation associated with psychosis . Following the initial dose , three more doses could be given 4 h apart if needed during the 24-h period . Results : The mean BARS score had decreased 15 min after the first 20 mg IM dose and was statistically significantly lower than the 2 mg group at 30 min post-dose . The improvement with the 20 mg dose increased until 2 h , and was maintained until at least 4 h post-dose ( P<0.001 ) . Two hours after the first injection , almost all of the patients receiving ziprasidone 20 mg were BARS responders compared with just one-third of those receiving 2 mg ziprasidone ( P<0.001 ) . The calming effect of ziprasidone was also evident by the significant reduction in PANSS agitation items ( P<0.05 ) and CGI-severity at 4 h ( P=0.008 ) . Both ziprasidone doses were very well tolerated .  Ziprasidone IM 20 mg was not associated with EPS , dystonia , akathisia , respiratory depression or with excessive sedation . Conclusions : Ziprasidone IM 20 mg substantially and significantly reduced the symptoms of acute agitation in patients with psychotic disorders .  Ziprasidone 20 mg IM was very well tolerated and produced no dystonia or akathisia
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 .