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 .
Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study.
STUDY OBJECTIVE We determine whether droperidol , midazolam , or the combination is more effective for intramuscular sedation in violent and acute behavioral disturbance in the emergency department ( ED ) . METHODS We conducted a blinded r and omized controlled trial of intramuscular sedation for violent and acute behavioral disturbance , comparing droperidol ( 10 mg ) , midazolam ( 10 mg ) , and droperidol ( 5 mg)/midazolam ( 5 mg ) . Inclusion criteria were patients requiring physical restraint and parenteral sedation . The primary outcome was the duration of the violent and acute behavioral disturbance , defined as the time security staff were required . Secondary outcomes included time until additional sedation was administered , staff and patient injuries , further episodes of violent and acute behavioral disturbance , and drug-related adverse effects . RESULTS From 223 ED patients with violent and acute behavioral disturbance , 91 patients were included ; 33 received droperidol , 29 received midazolam , and 29 received the combination . There was no difference in the median duration of the violent and acute behavioral disturbance : 20 minutes ( interquartile range [ IQR ] 11 to 37 min ) for droperidol , 24 minutes ( IQR 13 to 35 minutes ) for midazolam , and 25 minutes ( IQR 15 to 38 minutes ) for the combination . Additional sedation was required in 11 ( 33 % ; 95 % confidence interval [ CI ] 19 % to 52 % ) droperidol patients , 18 ( 62 % ; 95 % CI 42 % to 79 % ) midazolam patients , and 12 ( 41 % ; 95 % CI 24 % to 61 % ) in the combination group . The hazard ratio for additional sedation in the midazolam versus droperidol group was 2.31 ( 95 % credible interval 1.01 to 4.71 ) ; for the combination versus droperidol , 1.18 ( 95 % credible interval 0.46 to 2.50 ) . Patient and staff injuries and number of further episodes of violent and acute behavioral disturbance did not differ between groups . There were two adverse effects for droperidol ( 6 % ; 95 % CI 1 % to 22 % ) , 8 for midazolam ( 28 % ; 95 % CI 13 % to 47 % ) , and 2 for the combination ( 7 % ; 95 % CI 1 % to 24 % ) . An abnormal QT occurred in 2 of 31 ( 6 % ; 95 % CI 1 % to 23 % ) droperidol patients , which was not different from the other groups . CONCLUSION Intramuscular droperidol and midazolam result ed in a similar duration of violent and acute behavioral disturbance , but more additional sedation was required with midazolam . Midazolam caused more adverse effects because of oversedation , and there was no evidence of QT prolongation associated with droperidol compared with midazolam
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 .