The severity of the psychosis (degree of impairment in reality testing) and the potential for harm will dictate the treatment setting. The best predictor of dangerousness remains the patient’s history. Therefore, maximal attempts should be made to review past medical records and obtain collateral information from family and friends. Presenting symptoms alone are not sufficient to determine a patient’s potential for harm.
Treatment is geared toward creating a safe and secure environment, free from
excess stimulation. Interaction with people and places that tend to agitate the
patient should be reduced. A calm approach will ease the symptoms and will
also facilitate a long-term trusting relationship. Any acute intervention (e.g.,
involuntary medication) must be weighed against the long-term consequences of
breech of trust. Many patients who have experienced severe side effects from
rapid administration of high dose medications in the past may be reluctant to take
any medication in the future.