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 .
Efficacy and safety of loxapine for inhalation in the treatment of agitation in patients with schizophrenia: a randomized, double-blind, placebo-controlled trial.
OBJECTIVE The objective of this study was to assess the efficacy and safety of inhaled loxapine in the treatment of agitation in patients with psychotic disorders . METHOD In this r and omized , double-blind , placebo-controlled study , 129 agitated patients with schizophrenia or schizoaffective disorder ( DSM-IV criteria ) were r and omized to receive in a clinical or hospital setting a single inhalation of 5 or 10 mg of loxapine or placebo administered using the Staccato loxapine for inhalation device . The inhalation device delivered thermally generated drug aerosol to the deep lung for rapid absorption . The primary efficacy measure was change on the Positive and Negative Syndrome Scale-excited component ( PANSS-EC ) 2 hours following treatment . Secondary outcomes included the Clinical Global Impressions-Improvement scale ( CGI-I ) , Behavioral Activity Rating Scale ( BARS ) , and time to first rescue medication . The study was conducted between September 2006 and January 2007 . RESULTS Differences were statistically significant ( P < .05 ) between placebo and both 5-mg and 10-mg doses on the CGI-I and the CGI-I responder analyses at 2 hours and in time to first rescue medication , and they were statistically significant ( P < .05 ) between placebo and 10-mg loxapine on the PANSS-EC 20 minutes after administration continuing through 2 hours and in change from baseline BARS . Three serious adverse events occurred at least 6 days after treatment , but none were judged related to study treatment . The most common adverse events were sedation and dysgeusia ( 22 % and 17 % , respectively , in the 10-mg group , and 14 % and 9 % , respectively , in the placebo group ) . CONCLUSIONS Inhaled loxapine was generally safe and well tolerated and produced rapid improvement in agitated patients with psychotic disorders . Statistically significant differences in efficacy were found for the 10-mg dose compared with placebo , with results suggesting 5 mg may be effective . The delivery of loxapine by inhalation may provide a rapid , well-tolerated option for treating acute psychotic agitation that allows patients to avoid the aversive effects and loss of autonomy often associated with use of intramuscular medications . Further investigation of this new loxapine formulation is warranted . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00369577
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 .