Rapid parenteral treatment of acute psychosis

Abstract

In the past 25 years, there has been widespread use of pharmacotherapy for the management of psychotic disturbances. Refinements in drug therapy have brought specific methods for particular clinical problems, such as megadose treatment for refractory patients 1,2 and maintenance therapy using conventional and long-acting neuroleptics to facilitate community adjustment. 3,4 For the management of acute psychosis, a number of oral and parenteral procedures, employing a variety of neuroleptic agents and dosage schedules, are described in the literature as “rapid” treatment techniques. However, there is lack of agreement about the terms used in describing these techniques as well as lack of clarity about their relative efficacy. More specifically, at the present time it is unclear whether there is advantage to administering neuroleptic by frequent injections over a period of hours, and whether administering neuroleptic via different routes (intramuscular, intravenous, or oral) results in different rates of therapeutic change. This article reviews the use of rapid parenteral techniques, and considers the evidence regarding the safety and effectiveness of these procedures for the management of acute psychosis.