Sustaining short-term gains for future progress

Management of patients with acute psychosis represents a considerable challenge for many reasons. As acute psychosis is considered to be a psychiatric emergency that requires immediate and effective intervention, pharmacotherapy with antipsychotic drugs is the mainstay of treatment. The key treatment goals are to calm the agitated, assaultive, violent or disruptive patient, to minimize the danger to self and others and to achieve a smooth transition from intramuscular to oral maintenance treatment with mimimal side-effects. In most circumstances intramuscular formulations of antipsychotic drugs are the optimal treatment choice. However, only the conventional antipsychotics are currently available as intramuscular formulations and unfavourable tolerability profiles reduce the benefit/risk ratio and may make future transition to oral treatment problematic. An intramuscular formulation of an atypical antipsychotic medication would have significant advantages, not only during the acute psychotic phase but also during transition to oral maintenance treatment by enabling an effective and well-tolerated changeover from intramuscular to oral drug treatment.