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 .
Cluster-randomized controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia.
OBJECTIVE This r and omized controlled trial studied whether seclusion and restraint could be prevented in the psychiatric care of persons with schizophrenia without an increase of violence . METHODS Over the course of a year , 13 wards of a secured national psychiatric hospital in Finl and received information about seclusion and restraint prevention . Four high-security wards ( N=88 beds ) for men with psychotic illness were then stratified by coercion rates and r and omly assigned to two equal groups . In the intervention wards , staff , patients , and doctors were trained for six months in applying six core strategies to prevent seclusion-restraint ; six months of supervised intervention followed . Poisson 's regression analyses compared monthly incidence rate ratios ( IRRs ) of coercion and violence ( per 100 patient-days ) . RESULTS The proportion of patient-days with seclusion , restraint , or room observation declined from 30 % to 15 % for intervention wards ( IRR=.88 , 95 % confidence interval [CI]=.86-.90 , p<.001 ) versus from 25 % to 19 % for control wards ( IRR=.97 , CI=.93 - 1.01 , p=.056 ) .  Seclusion-restraint time decreased from 110 to 56 hours per 100 patient-days for intervention wards ( IRR=.85 , CI=.78-.92 , p<.001 ) but increased from 133 to 150 hours for control wards ( IRR=1.09 , CI=.94 - 1.25 , p=.24 ) . Incidence of violence decreased from 1.1 % to .4 % for the intervention wards and from .1 % to .0 % for control wards . Between-groups differences were significant for  seclusion-restraint-observation days ( p=.001 ) and  seclusion-restraint time ( p=.001 ) but not for violence ( p=.91 ) . CONCLUSIONS Seclusion and restraint were prevented without an increase of violence in wards for men with schizophrenia and violent behavior . A similar reduction may also be feasible under less extreme circumstances
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 .