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 .
Chemical restraint for the agitated patient in the emergency department: lorazepam versus droperidol.
Patients presenting to the emergency department with acute agitation frequently require physical and chemical restraint . To determine the efficacy of lorazepam vs. droperidol , we conducted a prospect i ve , r and omized study of violently agitated patients requiring chemical restraint . Patients were r and omized to receive either lorazepam or droperidol i.v . A six-point sedation scale was used . Sedation scores were recorded at time 0 , 5 , 10 , 15 , 30 , and 60 min . Vital signs were compared at time 0 and at 60 min . Repeat dosages of each drug could be given at 30 min . Toxicology screen , ethanol and creatinine phosphokinase levels were obtained . A total of 202 patients were evaluated . One hundred patients received lorazepam and 102 patients received droperidol .  Agitation was attributed to methamphetamine toxicity in 146 patients ( 72 % ) , cocaine toxicity in 28 ( 14 % ) , psychiatric illness in 20 ( 10 % ) , and ethanol withdrawal in 8 ( 4 % ) . Ethanol intoxication was present in 98 patients ( 49 % ) . Both drugs had similar sedation profiles at 5 min . Patients receiving droperidol had significantly lower sedation scores at times 10 , 15 , 30 , and 60 than lorazepam . More repeat doses of lorazepam were given ( 40 ) than droperidol ( 8) at 30 min . We conclude that droperidol produces a more rapid and better sedation than lorazepam at the doses used in this study in agitated patients requiring chemical restraint . Lorazepam is more likely to require repeat dosing than droperidol .  Methamphetamine toxicity was present in the majority of patients in this study
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 .