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 .
Quetiapine monotherapy for mania associated with bipolar disorder: combined analysis of two international, double-blind, randomised, placebo-controlled studies
ABSTRACT Objective : To evaluate the efficacy and safety of quetiapine monotherapy for mania in bipolar disorder by an a priori defined combined analysis of data from two placebo-controlled studies . Method : The intent-to-treat ( ITT ) population s from two studies of patients with DSM-IV bipolar I disorder , manic episode , r and omised to 12 weeks of double-blind treatment with quetiapine ( up to 800 mg/day ) or placebo were combined . The primary efficacy endpoint was change in Young Mania Rating Scale ( YMRS ) score from baseline to Day 21 . Secondary endpoints included change from baseline in YMRS to Day 84 , YMRS response and remission rates and change from baseline to Days 21 and 84 in the Montgomery – Asberg Depression Rating Scale ( MADRS ) , Clinical Global Impressions ( CGI ) , Clinical Global Impressions – Bipolar ( CGI-BP ) and the Positive and Negative Syndrome Scale ( PANSS ) . These endpoints were analysed as continuous variables , using an analysis of covariance ( ANCOVA ) , with the baseline as covariate . In order to account for any difference in response between studies , the analyses were stratified by study as a fixed effect , and centre as a r and om effect . The Cochran – Mantel – Haenszel test was used to analyse binary variables . A chi square test was used to compare the frequency of adverse events between the treatment groups . Results : The combined analysis included a total of 403 patients from two quetiapine monotherapy studies in patients with bipolar I disorder . A significant improvement in YMRS score was observed from Day 4 ( p = 0.021 ) onward in the quetiapine group compared with placebo . The treatment advantage of quetiapine over placebo continued to increase to Day 21 ( p < 0.001 ) and Day 84 ( p < 0.001 ) . Significantly more quetiapine-treated than placebo-treated patients achieved a response ( p < 0.001 ) . The average quetiapine dose in responders was approximately 600 mg daily . Of adverse events occurring in ≥ 5 % of patients , quetiapine-treated patients had a significantly greater incidence versus placebo of somnolence ( 16.3 % vs. 4.0 % ) , dry mouth ( 15.8 % vs. 3 % ) , weight gain ( 9.1 % vs. 1.5 % ) and dizziness ( 6.7 % vs. 2.5 % ) . Conclusions : The data from this combined analysis support the results from the individual studies and indicate that quetiapine monotherapy is effective across a broad range of mood symptoms , fast-acting and well tolerated in the treatment of mania
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 .