This chapter focuses on the management of acutely disturbed patients in psychiatric intensive care units (PICUs). It provides an overview of the nature of acutely disturbed patients, their symptoms and behaviours and the general challenges faced in managing their disturbance. The chapter discusses a philosophy for dealing with disturbed patients, appropriate assessment and care planning and a range of interventions that can be utilised, including verbal de-escalation, medication, physical intervention, seclusion and segregation. It also explores the development of activity and engagement programs for acute disturbance and the training and experience mix required for effective management. The roles of multidisciplinary team (MDT) members in the management of acute disturbance are outlined as well. The chapter highlights the prevalence of violence and aggression in healthcare settings and the importance of creating an informed and supported environment for staff to minimise risks. It concludes with recommendations for ensuring a safe environment and a philosophy of person-centred care in the management of acutely disturbed patients.