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 .
Intravenous droperidol or olanzapine as an adjunct to midazolam for the acutely agitated patient: a multicenter, randomized, double-blind, placebo-controlled clinical trial.
STUDY OBJECTIVE Parenteral benzodiazepines or antipsychotics are often used to manage acute agitation in emergency department ( ED ) setting s in which alternative strategies have failed or are not feasible . There are scant data comparing parenteral medication regimens . We aim to determine the efficacy and safety of intravenous droperidol or olanzapine as an adjunct to intravenous midazolam for rapid patient sedation . METHODS We undertook a r and omized , double-blind , placebo-controlled , double-dummy , clinical trial in 3 EDs ( August 2009 to March 2011 ) . Adult patients ( n=336 ) requiring intravenous drug sedation for acute agitation were r and omized to receive a saline solution ( control ) , droperidol ( 5 mg ) , or olanzapine ( 5 mg ) bolus . This was immediately followed by incremental intravenous midazolam boluses ( 2.5 to 5 mg ) until sedation was achieved . The primary outcome was time to sedation . Secondary outcomes were need for " rescue " drugs and adverse events . RESULTS Three hundred thirty-six patients were r and omized to the 3 groups . Baseline characteristics were similar across groups . The differences in medians for times to sedation between the control and droperidol and control and olanzapine groups were 4 minutes ( 95 % confidence interval [ CI ] 1 to 6 minutes ) and 5 minutes ( 95 % CI 1 to 6 minutes ) , respectively . At any point , patients in the droperidol and olanzapine groups were approximately 1.6 times more likely to be se date d compared with controls : droperidol and olanzapine group hazard ratios were 1.61 ( 95 % CI 1.23 to 2.11 ) and 1.66 ( 95 % CI 1.27 to 2.17 ) , respectively . Patients in the droperidol and olanzapine groups required less rescue or alternative drug use after initial sedation . The 3 groups ' adverse event profiles and lengths of stay did not differ . CONCLUSION Intravenous droperidol or olanzapine as an adjunct to midazolam is effective and decreases the time to adequate sedation compared with midazolam alone
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 .