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 .
A randomized, double-blind, placebo-controlled study of rapid-acting intramuscular olanzapine in Japanese patients for schizophrenia with acute agitation
Background Olanzapine rapid-acting intramuscular ( IM ) injection is an atypical antipsychotic drug already used overseas and recently approved in Japan . The objective of this study was to confirm the efficacy of rapid-acting IM olanzapine 10 mg was greater than IM placebo in patients with exacerbation of schizophrenia with acute psychotic agitation by comparing changes from baseline to 2 hours after the first IM injection , as measured by the Positive and Negative Syndrome Scale-Excited Component ( PANSS-EC ) total score . Methods We conducted a placebo-controlled , r and omized , double-blind , parallel-group study in Japanese patients diagnosed with schizophrenia according to the diagnostic criteria specified in the DSM-IV-TR . Patients were r and omized to 2 treatment groups : IM olanzapine ( 10 mg ) or IM placebo . The primary efficacy outcome was the change in PANSS-EC from baseline to 2 hours after the first IM injection . Treatment groups were compared with an analysis of variance model which included treatment and site as factors . During the 24-hour treatment period , safety was assessed by clinical examination and laboratory investigations , electrocardiograms , extrapyramidal symptoms scales , and recording spontaneously reported adverse events . Results Of the 91 r and omized patients , 90 patients ( 45 IM olanzapine-group ; 45 IM placebo-group ) were in the full analysis set . The mean change of PANSS-EC total score from baseline to 2 hours after the first IM injection ( mean±st and ard deviation ) was −9.2±4.5 for the IM olanzapine group and −2.8±5.6 for the IM placebo group . The difference between treatment groups was statistically significant ( p<.001 ) . There were no deaths , serious adverse events , treatment-emergent adverse events ( TEAEs ) leading to discontinuation , severe TEAEs , or instances of oversedation in this study . There were no statistically significant differences between treatment groups in the proportion of patients with potentially clinical ly significant changes in laboratory tests , vital signs ( blood pressure and pulse rate ) , electrocardiograms , and treatment-emergent extrapyramidal symptoms . Conclusion The efficacy of IM olanzapine 10 mg in patients with exacerbation of schizophrenia with acute psychotic agitation was greater than IM placebo in the primary efficacy measure , PANSS-EC . Intramuscular olanzapine 10 mg was shown to be generally safe and tolerable , and could be a new option for treatment of schizophrenia in Japan . Trial Registration
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 .