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 clinical trial comparing intravenous midazolam and droperidol for sedation of the acutely agitated patient in the emergency department.
STUDY OBJECTIVE We compare intravenous midazolam and droperidol for the onset of sedation of acutely agitated patients in the emergency department ( ED ) . METHODS This was a double-blind , r and omized , clinical trial set in the ED of a university teaching hospital . Subjects were adults , acutely agitated because of mental illness , intoxication , or both , who received midazolam or droperidol , 5 mg intravenously , every 5 minutes until se date d. We analyzed time to sedation using survival analysis , median times to sedation , and proportions se date d at 5 and 10 minutes . RESULTS Seventy-four patients received midazolam ; 79 patients , droperidol .  Survival analysis showed no difference in time to sedation ( hazard ratio 0.86 ; 95 % confidence interval [ CI ] 0.61 to 1.23 ) , P=.42 . Median time to sedation was 6.5 minutes for midazolam ( median dose 5 mg ) and 8 minutes for droperidol ( median dose 10 mg ) , P=.075 ( effect size 1.5 minutes ; 95 % CI 0 to 4 minutes ) . At 5 minutes , 33 of 74 ( 44.6 % ) patients from the midazolam group were adequately se date d compared with 13 of 79 ( 16.5 % ) patients from the droperidol group , a difference of 28.1 % ( 95 % CI 12.9 % to 43.4 % ; P<.001 ) . By 10 minutes , 41 of 74 ( 55.4 % ) from the midazolam group were se date d compared to 42 of 79 ( 53.2 % ) from droperidol , a difference of 2.2 % ( 95 % CI -14.9 % to 19.3 % ; P=.91 ) . Eleven adverse events occurred in the midazolam group and 10 in the droperidol group . Three patients required active airway management ( 3 patients with assisted ventilation and 1 patient intubated ) ; all received midazolam . CONCLUSION There is no difference in onset of adequate sedation of agitated patients using midazolam or droperidol . Patients se date d with midazolam may have an increased need for active airway management
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 .