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Medications for acute psychosis
What are the pharmacologic treatment options for acute psychosis?
First-line agents include potent typical (e.g., haloperidol, perphenazine) and second-generation (e.g., risperidone, olanzapine, quetiapine, ziprasidone, or aripiprazole) antipsychotics with the selection depending on previous response, side-effect profiles and patient preference, and other pharmacodynamic and kinetic considerations.
The availability of risperidone, olanzapine, aripiprazole, and haloperidol in multiple preparations (e.g., oral, intramuscular, long-acting injectable, etc.) makes these preferred agents for many situations.
Adjunctive use of benzodiazepines, if not contraindicated, may be helpful for the agitated psychotic patient.
SGAs (many of which have antidepressant effects) alone or in combination with a mood stabilizer or an antidepressant can treat comorbid mood and psychotic symptoms (e.g., schizoaffective disorder).
Is the use of combinations of antipsychotics evidence based?
The use of combinations of antipsychotics, while popular, is not supported by evidence or guideline recommendations.
