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 .
Efficacy and safety of intramuscular aripiprazole in patients with acute agitation: a randomized, double-blind, placebo-controlled trial.
OBJECTIVE This multicenter , r and omized , double-blind , placebo-controlled study evaluated the efficacy and safety of intramuscular ( IM ) aripiprazole in patients with acute agitation with a DSM-IV diagnosis of schizophrenia , schizoaffective disorder , or schizo-phreniform disorder . METHOD Patients were r and omly assigned to IM aripiprazole 1 mg , 5.25 mg , 9.75 mg , or 15 mg ; IM haloperidol 7.5 mg ; or placebo and observed for 24 hours . The primary efficacy measure was mean change in the Positive and Negative Syndrome Scale-Excited Component ( PEC ) score from baseline to 2 hours after initial dosing . Secondary measures included the Agitation-Calmness Evaluation Scale ( ACES ) score . The study was carried out at 50 centers worldwide between April 2002 and January 2003 . RESULTS A total of 357 patients were r and omly assigned to treatment . Intramuscular aripiprazole 5.25 mg , 9.75 mg , and 15 mg and IM haloperidol 7.5 mg demonstrated significantly greater reduction in the primary efficacy measure versus placebo . These changes were statistically significant as early as 45 minutes for the IM aripiprazole 9.75-mg group , with a trend toward significance ( p = .051 ) at 30 minutes . Intramuscular haloperidol 7.5 mg first showed a significant reduction in PEC score versus placebo at 105 minutes . At 30 minutes , significantly more patients responded ( defined as a greater than or equal to 40 % reduction in PEC score ) to IM aripiprazole 9.75 mg versus placebo ( 27 % vs. 13 % , p = .05 ) . Intramuscular aripiprazole 9.75 mg significantly improved agitation , without oversedation , as measured by change in ACES score from baseline to 2 hours versus placebo ( p = .003 ) . No patient discontinued the study because of treatment-emergent adverse events . Extrapyramidal symptoms occurred most frequently in the IM haloperidol group . The most common adverse event in IM aripiprazole recipients was headache . CONCLUSION Intramuscular aripiprazole 9.75 mg is a rapidly effective and well-tolerated alternative to IM haloperidol for the control of agitation , without oversedation , in patients with schizophrenia , schizo-affective disorder , or schizophreniform disorder . CLINICAL TRIALS REGISTRATION Clinical Trials.gov identifier NCT00036127
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 .