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 .
Antimanic response to aripiprazole in bipolar I disorder patients is independent of the agitation level at baseline.
OBJECTIVE To examine the antimanic efficacy of the relatively nonsedating antipsychotic aripiprazole in patients with bipolar I disorder and high or low baseline levels of agitation . METHOD Data were pooled for this post hoc analysis from two 3-week , placebo-controlled trials of aripiprazole in acute mania ( DSM-IV ) . Patients r and omly assigned to aripiprazole 30 mg/day ( N = 259 ) or placebo ( N = 254 ) were classified as having either high ( Positive and Negative Syndrome Scale [ PANSS ] Excited Component [ PEC ] score of > or=14 and a score of > or= 4 on at least one PEC item ) or low ( PEC < 14 ) levels of agitation at baseline .  Efficacy measures were changes in Young Mania Rating Scale ( YMRS ) scores , Clinical Global Impressions-Bipolar ( CGI-BP ) scores , and PEC scores . Efficacy and agitation measurements were assessed by analysis of covariance . RESULTS From the first week of therapy onward , aripiprazole-treated subjects had significantly greater reduction from baseline in YMRS total scores than placebo-treated subjects in both the high- and low-agitation groups ( p < .05 for both groups ) and significantly improved CGI-BP scores vs. placebo at end point ( p < .05 for both ) . In highly agitated patients receiving aripiprazole , PEC scores were significantly decreased versus placebo at end point ( p < .05 ) . In patients with low agitation receiving aripiprazole , no increases in PEC scores were seen , and a significant reduction in agitation symptoms was apparent after adjustment for baseline PEC scores . CONCLUSIONS Aripiprazole was superior to placebo in reducing the severity of both mania and agitation in highly agitated patients with bipolar I disorder and showed significant antimanic activity in patients with low levels of agitation without increasing agitation . These findings suggest that aripiprazole 's antimanic effect is specific and not limited to control of agitation through sedation
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 .