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 in the acute management of psychomotor agitation.
STUDY OBJECTIVE To assess acute efficacy and safety of 9.75 mg of intramuscular ( IM ) injections of the atypical antipsychiatric aripiprazole in patients with schizophrenia or bipolar disorder and acute agitation . DESIGN Open-label trial of IM injections of aripiprazole and 24-hour monitoring of clinical response in patients with major psychoses and acute agitation . Partial analysis of blood levels of the administered drug to correlate with clinical response . SETTING Acute psychiatric care wards in a single university hospital . PATIENTS A total of 201 acutely agitated patients ( 79 with schizophrenia and 122 with bipolar disorder I ) . INTERVENTION Aripiprazole 9.75 mg IM injection . MEASUREMENTS AND MAIN RESULTS We evaluated clinical response using the Excitatory Component of the Positive and Negative Syndrome Scale ( PANSS-EC ) , the Agitation/Calmness Evaluation Scale ( ACES ) , and the Clinical Global Impressions scale ( CGI ) . Assessment s were conducted 30 , 60 , 90 , and 120 minutes and 24 hours after the first injection for PANSS-EC and ACES , and 2 , 4 , 6 , and 24 hours for CGI . Response was at least a 40 % decrease in PANSS-EC scores . We measured serum aripiprazole and dehydroaripiprazole levels in a sub sample . IM aripiprazole significantly improved clinical measures . PANSS-EC improved progressively , starting after 30 minutes . ACES improved after 90 minutes and continued thereafter . Effects were sustained , with steadily decreasing CGI scores , until the 24th hour . Response rate was 83.6 % after 2 hours , but with repeat injections , it rose to over 90 % with no differences among diagnostic groups . Although there were gender differences in the response to individual PANSS-EC items , the responses were similar overall . Neither clinical monitoring nor patient reporting revealed any side effects . No therapeutic window was identified , and levels did not correlate with any clinical measure . CONCLUSION Aripiprazole was effective and safe in reducing acute agitation in patients with bipolar disorder or schizophrenia . Our results compare favorably to double-blind trials , probably due to higher expectations in trials involving no placebo arm . Absence of side effects could be related to the short observation time
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 .