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 Agitation in Patients With Bipolar Disorder: Efficacy and Safety of Intramuscular Aripiprazole
To investigate the efficacy and safety of intramuscular ( IM ) aripiprazole for the treatment of agitation in patients with bipolar I disorder , manic or mixed episodes . In total , 301 patients experiencing acute agitation were r and omized to IM aripiprazole 9.75 mg per injection ( n = 78 ) , IM aripiprazole 15 mg per injection ( n = 78 ) , IM lorazepam 2 mg per injection ( n = 70 ) , or IM placebo ( n = 75 ) in this double-blind multicenter study . Patients could receive up to 3 injections over 24 hours . Primary efficacy measure was mean change in Positive and Negative Syndrome Scale Excited Component score from baseline at 2 hours after first injection . Mean improvements in Positive and Negative Syndrome Scale Excited Component score at 2 hours were significantly greater with IM aripiprazole ( 9.75 mg , −8.7 ; 15 mg , −8.7 ) and IM lorazepam ( −9.6 ) versus IM placebo ( −5.8 ; P ≤ 0.001 ) . For all other efficacy measures , all 3 active treatments showed significantly greater improvements over IM placebo at 2 hours ( P < 0.05 ) , with similar improvements across the active treatments . Significant differences over IM placebo were seen by 45 to 60 minutes for several efficacy parameters . Both IM aripiprazole doses were well tolerated ; the safety profile was similar to oral aripiprazole . Oversedation ( Agitation-Calmness Evaluation Scale score of 8 or 9 ) during 2 hours after first injection was less frequent with IM aripiprazole 9.75 mg ( 6.7 % ) and IM placebo ( 6.8 % ) versus IM aripiprazole 15 mg ( 17.3 % ) and IM lorazepam ( 19.1 % ) . IM aripiprazole 9.75 and 15 mg are effective and well tolerated for acute agitation in bipolar disorder , although the low incidence of oversedation suggests a risk-benefit profile for IM aripiprazole 9.75 mg
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 .