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 .
Management of acute undifferentiated agitation in the emergency department: a randomized double-blind trial of droperidol, ziprasidone, and midazolam.
OBJECTIVES To compare the efficacy of sedation , need for rescue sedation , rates of respiratory depression , and complications of droperidol , ziprasidone , and midazolam when used for the treatment of emergency department ( ED ) patients requiring sedation for acute undifferentiated agitation . METHODS A prospect i ve , r and omized , double-blind trial of agitated ED patients requiring emergent sedation  was performed . Patients were r and omized to receive droperidol 5 mg , ziprasidone 20 mg , or midazolam 5 mg intramuscularly . Interval measurements were made at 0 , 15 , 30 , 45 , 60 , and 120 minutes and included Altered Mental Status Scale ( AMS ) scores , oxygen saturations , and end-tidal carbon dioxide levels . RESULTS A total of 144 patients were enrolled ; 50 patients received droperidol , 46 received ziprasidone , and 48 received midazolam .  Adequate sedation ( mean AMS score < 0 ) was achieved at 15 minutes in patients receiving midazolam ( mean AMS score , -0.81 ) and 30 minutes for patients receiving droperidol ( mean AMS score , -1.3 ) and ziprasidone ( mean AMS score , -0.74 ) . Rescue medication for sedation was necessary in 38 of 144 patients ( droperidol , 5 of 50 ; ziprasidone , 9 of 46 ; midazolam , 24 of 48 ; p < 0.05 ) . No cardiac dysrhythmias were identified in any treatment group . Respiratory depression that clinical ly required treatment with supplemental oxygen occurred in 21 of 144 patients ( droperidol , 4 of 50 ; ziprasidone , 7 of 46 ; midazolam , 10 of 48 ; p = 0.20 ) . No patients required endotracheal intubation . CONCLUSIONS Acutely agitated ED patients se date d with droperidol or ziprasidone required rescue medications to achieve adequate sedation less frequently than those se date d with midazolam . The onset of adequate sedation is delayed with ziprasidone , relative to the other agents
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 .