Objective: To review current data concerning the management of agitated or aggressive patients. Method: A search was performed in the PubMed and Web of Science databases and empirical articles and reviews about pharmacological and non-pharmacological interventions for the management of agitation and/or violence were selected and analyzed. Results: The non-pharmacological management of agitation/aggression involves the physical organization of the emergency department and the adequacy of the behavior and attitudes of health professionals. The main goal of pharmacological management is rapid tranquilization, aimed at reducing symptoms of agitation and aggression without inducing deep or prolonged sedation, keeping the patient calm but fully or partially responsive. Polypharmacy should be avoided and medication doses should be as low as possible, adjusted according to clinical requirements. Intramuscular administration of drugs should be considered as a last option. Available options related to the use of antipsychotics and benzodiazepines are described and discussed. The physical management by means of mechanical restraint may be necessary in violent situations involving risks for the patient or staff and must be performed according to strict criteria. Conclusion: Procedures must be carefully implemented to avoid physical and emotional complications for patients and staff. Descriptors

Converging evidence indicates that dysfunctions in glutamatergic neurotransmission and in the glutamate-glutamine cycle play a role in the pathophysiology of schizophrenia. Here, we investigated glutamate and glutamine levels in the blood of patients with recent onset schizophrenia or chronic schizophrenia compared to healthy controls. Compared with healthy controls, patients with recent onset schizophrenia showed increased glutamine/glutamate ratio, while patients with chronic schizophrenia showed decreased glutamine/glutamate ratio. Results indicate that circulating glutamate and glutamine levels exhibit a dual behavior in schizophrenia, with an increase of glutamine/glutamate ratio at the onset of schizophrenia followed by a decrease with progression of the disorder. Further studies are warranted to elucidate the mechanisms and consequences of changes in circulating glutamate and glutamine in schizophrenia.

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