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 .
A Double-Blind, Randomized Comparison of the Efficacy and Safety of Intramuscular Injections of Olanzapine, Lorazepam, or Placebo in Treating Acutely Agitated Patients Diagnosed With Bipolar Mania
There are no rapid-acting intramuscular formulations of atypical antipsychotics available for quickly calming an agitated patient with bipolar disorder . In this study , 201 agitated patients with bipolar mania were r and omly assigned to receive one to three injections of the atypical antipsychotic olanzapine ( 10 mg , first two injections ; 5 mg , third injection ) , the benzodiazepine lorazepam ( 2 mg , first two injections ; 1 mg , third injection ) , or placebo ( placebo , first two injections ; olanzapine , 10 mg , third injection ) within a 24-hour period . Agitation was measured at baseline , every 30 minutes for the first 2 hours , and at 24 hours after the first injection using the Positive and Negative Syndrome Scale – Excited Component subscale and two additional agitation scales . At 2 hours after the first injection , patients treated with olanzapine showed a significantly greater reduction in scores on all agitation scales compared with patients treated with either placebo or lorazepam . At 24 hours after the first injection , olanzapine remained statistically superior to placebo in reducing agitation in patients with acute mania , whereas patients treated with lorazepam were not significantly different from those treated with placebo or olanzapine . Furthermore , no significant differences among the three treatment groups were observed in safety measures , including treatment-emergent extrapyramidal symptoms , the incidence of acute dystonia , or QTc interval changes . These findings suggest that intramuscular olanzapine is a safe and effective treatment for reducing acute agitation in patients with bipolar 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 .