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 .
Comparison of Intramuscular Olanzapine, Orally Disintegrating Olanzapine Tablets, Oral Risperidone Solution, and Intramuscular Haloperidol in the Management of Acute Agitation in an Acute Care Psychiatric Ward in Taiwan
Introduction : The purpose of this study was to compare efficacy and safety among intramuscular olanzapine , intramuscular haloperidol , orally disintegrating olanzapine tablets , and oral risperidone solution for agitated patients with psychosis during the first 24 hours of treatment in an acute care psychiatric ward . Methods : Forty-two in patients from an acute care psychiatric ward of a medical center in central Taiwan were enrolled . They were r and omly assigned to 1 of the 4 treatment groups ( 10-mg intramuscular olanzapine , 10-mg olanzapine oral disintegrating tablet , 3-mg oral risperidone solution , or 7.5-mg intramuscular haloperidol ) . Agitation was measured by using the excited component of the Positive and Negative Syndrome Scale ( PANSS-EC ) , the Agitation-Calmness Evaluation Scale , and the Clinical Global Impression-Severity Scale during the first 24 hours . Results : There were significant differences in the PANSS-EC total scores for the 4 intervention groups at 15 , 30 , 45 , 60 , 75 , and 90 minutes after the initiation of treatment . More significant differences were found early in the treatment . In the post hoc analysis , the patients who received intramuscular olanzapine or orally disintegrating olanzapine tablets showed significantly greater improvement in PANSS-EC scores than did patients who received intramuscular haloperidol at points 15 , 30 , 45 , 60 , 75 , and 90 minutes after injection . Conclusions : These findings suggest that intramuscular olanzapine , orally disintegrating olanzapine tablets , and oral risperidone solution are as effective treatments as intramuscular haloperidol for patients with acute agitation . Intramuscular olanzapine and disintegrating olanzapine tablets are more effective than intramuscular haloperidol in the early phase of the intervention . There is no significant difference in effectiveness among intramuscular olanzapine , orally disintegrating olanzapine tablets , and oral risperidone solution
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 .