Guidelines for the acute use of antipsychotic drugs

Before initiating treatment, obtain a medical history and a psychiatric history. Baseline laboratory studies are also indicated if they have not already been completed as part of the initial evaluation of the patient. An evaluation for the presence of any abnormal movements is also advisable. An electrocardiogram should be considered for patients with a history of cardiac problems. 

After discussion with the patient and family about the risks and benefits of treatment, select the appropriate antipsychotic agent on the basis of the patient s physical status, the side-effect profile of the drug, and the patient s previous responses to medication, if known. 

Educate the patient and family about the risks of developing metabolic syndrome, diabetes, obesity, dyslipidemia, and tardive dyskinesia. Document this discussion in the patient s chart. 

Initiate treatment with antipsychotic medications at low to moderate doses, depending on the patient s history and clinical presentation. Titrate as tolerated to the target dose (Table 4-1). 

In patients with acute agitation, a sedative such as lorazepam (2 mg) may be effective. 

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As with antidepressant therapy, reversal of psychosis is often gradual and may occur over several weeks to several months. Guidelines for the acute use of antipsychotic drugs are summarized in Table 4— 2 usual dosages for each of the commonly used antipsychotic drugs are summarized in Table 4—1. 

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