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 .
Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. Ziprasidone I.M. Study Group.
BACKGROUND This 7-day , r and omized , open-label , multicenter , international study compared the efficacy and tolerability of intramuscular ( i.m . ) ziprasidone with haloperidol i.m . and the transition from i.m . to oral treatment in hospitalized patients with acute psychotic agitation ( related to DSM-III-R diagnoses ) . METHOD Patients received up to 3 days of flexible-dose ziprasidone i.m . ( N = 90 ) or haloperidol i.m . ( N = 42 ) followed by oral treatment to day 7 . After an initial ziprasidone i.m . dose of 10 mg , subsequent i.m . doses of 5 to 20 mg could be given every 4 to 6 hours ( maximum daily dose = 80 mg ) if needed , followed by oral ziprasidone , 80 - 200 mg/day . Haloperidol i.m . doses of 2.5 to 10 mg were given on entry , followed by 2.5 to 10 mg i.m . every 4 to 6 hours ( maximum daily dose = 40 mg ) if needed , then by oral haloperidol , 10 - 80 mg/day . RESULTS The mean reductions in Brief Psychiatric Rating Scale ( BPRS ) total , BPRS agitation items , and Clinical Global Impressions-Severity scale scores were statistically significantly greater ( p < .05 , p < .01 , and p < .01 , respectively ) after ziprasidone i.m . treatment compared with haloperidol i.m . treatment . Further reductions in these scores also occurred in both groups following transition to oral treatment . Ziprasidone was associated with a lower incidence of movement disorders and a reduced requirement for anticholinergic medication during both i.m . and oral treatment compared with haloperidol .  Movement disorder scale scores improved with ziprasidone i.m . and oral treatment , but deteriorated with haloperidol . Other adverse events were rare with both treatments . CONCLUSION Ziprasidone i.m . was significantly more effective in reducing the symptoms of acute psychosis and was better tolerated than haloperidol i.m . , particularly in movement disorders . The transition from ziprasidone i.m . to oral ziprasidone was effective and well tolerated
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 .