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 aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: a double-blind, placebo-controlled comparison with intramuscular haloperidol
Introduction This double-blind , placebo-controlled study investigated the efficacy and safety of intramuscular ( IM ) aripiprazole and IM haloperidol for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder . Material s and methods Four-hundred and forty-eight patients were r and omized ( 2:2:1 ratio ) to IM aripiprazole 9.75 mg , IM haloperidol 6.5 mg , or IM placebo . Patients could receive up to three injections over the first 24 h , with second and third injections administered ≥2 and ≥4 h , respectively , after the first if deemed clinical ly necessary . Primary efficacy measure was mean change in Positive and Negative Syndrome Scale Excited Component ( PEC ) score from baseline to 2 h. Results Mean improvement in PEC at 2 h was significantly greater for IM aripiprazole ( −7.27 ) vs placebo ( −4.78 ; p<0.001 ) ; IM aripiprazole was noninferior to IM haloperidol ( −7.75 ) on PEC . All secondary efficacy measures showed significantly greater improvements at 2 h for IM aripiprazole and IM haloperidol over placebo . Mean number of injections/patient and percentage of patients requiring benzodiazepines were significantly lower for IM aripiprazole vs placebo ( p<0.01 ) . IM aripiprazole was well tolerated . Extrapyramidal symptom-related adverse events were similar for aripiprazole ( 1.7 % ) and placebo ( 2.3 % ) and lower than with haloperidol ( 12.6 % ) . Conclusion These results show that IM aripiprazole is an effective treatment , comparable to IM haloperidol , and well-tolerated for acute agitation in patients with schizophrenia
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 .