AGItated Patients Management: intraNASAL Midazolam vs Intramuscular Loxapine

Inclusion Criteria:

• Age 18 to 60 years;

• Agitated Patient whose somatic or psychiatric aetiology cannot be diagnosed in anemergency situation and who need a sedation in a hospital emergency setting due tothe presence of unmanageable agitation with 3 major criteria.

Major criteria :

Agitation Pain Tolerance Tachypnea ( fr > 20)

And 1 minor criteria among :

Sweating Tactile Hyperthermia Medical care Non compliance Lack of tiring Unusual Strenght Inappropriately clothed, nudity

• Medical insurance The protocol can start if the THREE major inclusion criteria and ONE of the minor inclusion criteria are checked PRESENT and ALL the non-inclusion criteria are checked no.

Exclusion Criteria:

Subjects who meet any of the following criteria will be excluded from randomization into the study:

• Pregnancy

• Prisoners

• Contraindications to intranasal Midazolam or intramuscular Loxapine :

• Hypersensitivity to benzodiazepines or to any of the excipients (SodiumChloride, Hydrochloric Acid, Sodium Hydroxide, Water for Injection)

• Known hypersensitivity to loxapine or to any of the excipients (Polysorbate 80,propylene glycol, 20% v/v hydrochloric acid, water for injections, Nitrogen (Inert gas)

• Individuals who are in comatose states or have central nervous system (CNS)depression due to alcohol or are taking other depressant drugs

• Individuals with severe depressive states, spastic diseases, and withParkinson's disease, except in the case of dyskinesias due to levodopatreatment

• In combination with dopamine agonists except levodopa (amantadine,bromocriptine, lisuride, pergolide, piribedil, ropinirole, cabergoline,pramipexole, apomorphine) outside the patient with Parkinson's disease

• Individuals with a history of cerebrovascular accident or epilepsia

• Individuals in whom a significant elevation of blood pressure would constitutea serious hazard, such as patients with significant hypertension;

• Individuals with severe cardiac decompensation

• Patients with severe respiratory failure or acute respiratory depression

• Individuals with acute narrow angle glaucoma.