A Comprehensive Understanding of Psychomotor Agitation: From Causes to Hospital Care

Psychomotor agitation is a syndrome characterized by abnormal psychic and motor activation, with a concrete possibility of escalation to aggression or violence. It represents a frequent reason for attending emergency departments and can stem from various organic conditions and mental disorders. In emergency settings, prompt identification of the possible underlying cause and optimal management are crucial to ensure the safety of both patients and healthcare providers. However, current management strategies are based on evidence focused on too specific clinical contexts or aspects of patient care. This narrative review aims to consolidate available evidence on clinical-diagnostic evaluation, severity assessment, patient-specific interventions, and hospital management. Patients should always be approached using de-escalation techniques while providing a rapid and systematic assessment of the key differential elements between organic and psychiatric causes. Pharmacological interventions are recommended as secondary measures to ensure safety and should be directed at facilitating the therapeutic relationship. Physical restraints and seclusion should be used only as a last resort, for the shortest duration, and under strict medical supervision. There is a pressing need for the systematic organization of evidence into effective guidelines to optimize the clinical approach to psychomotor agitation, improving both patient outcomes and safety in emergency settings.