Atypical antipsychotic medications in the psychiatric emergency service

The physiologic and psychological impact of drugs administered in the emergency treatment of psychosis 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 now available and generally recommended as first-line treatment for psychosis, the slow titration schedules and lack of intramuscular preparations for these drugs often lead to the preferential use, and perhaps overuse, of conventional antipsychotics in emergency situations. A recent survey found that most medical directors of psychiatric emergency programs would prefer to administer an oral atypical agent if such an agent were found to be effective, safe, reliable, and practical to use. Preliminary results have shown the atypical antipsychotic risperidone to have efficacy equal to that of the conventional agent haloperidol in a direct comparison in the PES; further study is required, however, to determine the appropriateness of the use of risperidone and the other atypical antipsychotics in the emergency treatment of psychosis.