Atypical Antipsychotic Medications in the Psychiatric Emergency Service

The physiologic and psychological impact of drugs administered in the emergency treatment ofpsychosis endures much longer than the patient’s brief stay in the psychiatric emergency service(PES). Although newer antipsychotic agents with improved efficacy and side effect profiles are nowavailable and generally recommended as first-line treatment for psychosis, the slow titration schedulesand lack of intramuscular preparations for these drugs often lead to the preferential use, and perhapsoveruse, of conventional antipsychotics in emergency situations. A recent survey found that mostmedical directors of psychiatric emergency programs would prefer to administer an oral atypicalagent if such an agent were found to be effective, safe, reliable, and practical to use. Preliminary resultshave shown the atypical antipsychotic risperidone to have efficacy equal to that of the conventionalagent haloperidol in a direct comparison in the PES; further study is required, however, to determinethe appropriateness of the use of risperidone and the other atypical antipsychotics in theemergency treatment of psychosis.