CNS Drugs

, Volume 23, Issue 3, pp 193–212

Management of Patients Presenting with Acute Psychotic Episodes of Schizophrenia

Authors

    • Department of PsychiatryUniversity of Lille Medical School
  • Köksal Alptekin
    • Department of PsychiatrySchool of Medicine, Dokuz Eylul University
  • Mihai Gheorghe
    • Department of PsychiatryClinical Central Military Hospital
  • Mauro Mauri
    • Department of Clinical PsychiatryUniversity of Milan
  • José Manuel Olivares
    • Department of PsychiatryVigo University Hospital
  • Michael Riedel
    • Department of Psychiatry and PsychotherapyLudwig-Maximilian University
Review Article

DOI: 10.2165/00023210-200923030-00002

Cite this article as:
Thomas, P., Alptekin, K., Gheorghe, M. et al. CNS Drugs (2009) 23: 193. doi:10.2165/00023210-200923030-00002

Abstract

The initial management of patients with schizophrenia presenting to psychiatric emergency departments with an acute psychotic episode requires rapid decisions to be made by physicians concerning the treatment of individuals who are likely to be relatively uncooperative, agitated and lacking insight. The treatment decision must be adapted to the individual characteristics and needs of each patient. This article reviews the issues from the perspective of the initial management of acute psychosis as it is currently practised in Europe, and discusses the pragmatic implications for initial treatment decisions and the elaboration of a long-term treatment plan. Initially, administration of antipsychotics to control psychotic symptoms and benzodiazepines to control agitation represents the cornerstone of treatment. Oral medication is preferable to injectable forms wherever possible, and atypical antipsychotics are to be preferred over conventional agents because of their lower risk of extrapyramidal adverse effects, which are a major determinant of poor adherence to treatment. Whatever antipsychotic is chosen by the physician during the initial period, it is likely that it will need to be continued for many years, and it is thus important to take into account the long-term safety profile of the drug chosen, particularly in relation to extrapyramidal adverse effects, metabolic complications and quality of life. Building a therapeutic alliance with the patient and his/her family or carers is an important element that should be included in the initial management of psychosis. The long-term goal should be to minimize the risk of psychotic relapse through adequate treatment adherence.

Copyright information

© Adis Data Information BV 2009