Although psychotic symptoms will decrease over time with a supportive environment, medications remain the cornerstone for affording rapid relief. Since there is evidence that persistent psychosis has a poorer prognosis, rapid control of symptoms (within weeks instead of months) is warranted. There is little evidence, however, that rapid parenteral administration of high dose antipsychotics will speed recovery.
The choice of antipsychotic medication should be a joint decision between the physician and the patient. Past experience is a major determinant of which drug to use. Route of administration (oral vs. parenteral) as well as form (pills, capsules, or liquid concentrate) will also determine which drugs can be used. In general, medications can be separated according to probability of inducing side effects. These include sedation, orthostatic hypotension, and extrapyramidal side effects (EPS) that include the Parkinsonian symptoms of acute dystonia, akinesia, and akathesia. The age of the patient should be considered since acute dystonia is more likely in the younger population and orthostatic hypotension or sedation can have more severe consequences in the elderly. Clozapine, because of its unique potential to cause agranulocytosis, always requires special consideration before initiation.
Although psychotic symptoms will decrease over time with a supportive environment, medications remain the cornerstone for affording rapid relief. Since there is evidence that persistent psychosis has a poorer prognosis, rapid control of symptoms (within weeks instead of months) is warranted. There is little evidence, however, that rapid parenteral administration of high dose antipsychotics will speed recovery.
The choice of antipsychotic medication should be a joint decision between the physician and the patient. Past experience is a major determinant of which drug to use. Route of administration (oral vs. parenteral) as well as form (pills, capsules, or liquid concentrate) will also determine which drugs can be used. In general, medications can be separated according to probability of inducing side effects. These include sedation, orthostatic hypotension, and extrapyramidal side effects (EPS) that include the Parkinsonian symptoms of acute dystonia, akinesia, and akathesia. The age of the patient should be considered since acute dystonia is more likely in the younger population and orthostatic hypotension or sedation can have more severe consequences in the elderly. Clozapine, because of its unique potential to cause agranulocytosis, always requires special consideration before initiation.
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