Management of The acute psychotic patient
Remember explanation and support to family and patient.
Treatment of acute phase of psychosis (schizophrenia and related
psychoses)
• Hospitalisation usually necessary
• Drug treatment for the psychosis
1 When oral medication possible, fi rst-line treatment is one of the
second generation antipsychotics:
• olanzapine 5–10 mg (o) nocte or
• risperidone 1 mg (o) nocte titrated gradually to 2–4 mg (o) bd
(beware hypotension) or
• quetiapine 50 mg (o) bd ↑ as tolerated to 200 mg bd (by day 5) or
other
2 When parenteral medication required:
• haloperidol 2.5–10 mg IV or IM, initially,↑ 20 mg in 24 h, depending
on response or
• zuclopenthixol acetate 50–150 mg IM as a single dose add
• benztropine 1–2 mg (o) bd (to avoid dystonic reaction)
If dystonic reaction:
• benztropine 1–2 mg IV or IM
If very agitated, use:
• diazepam 5–20 mg (o) or 5–10 mg IV
Chronic phase of schizophrenia Long-term antipsychotic medication
recommended to prevent relapse.
Examples of oral medication regimens:
• olanzapine 10–20 mg (o) nocte or
• quetiapine 150 mg (o) bd or
• risperidone 0.5–1 mg (o) bd, up to 2–4 mg (o) bd
Use depot preparations if compliance is a problem (use test dose fi rst):
• fl uphenazine decanoate 12.5–50 mg IM, every 2–4 wks or
• haloperidol decanoate 50–200 mg IM, every 4 wks or
• fl upenthixol decanoate 20–40 mg IM, every 2–4 wks or
• zuclopenthixol deconate 100–400 mg IM every 2–4 wks
Resistant schizophrenia (options)
• clozapine 12.5 mg (o) bd initially increasing up to 300–600 mg/d
• olanzapine 5–20 mg (o)/d
Remember explanation and support to family and patient.
Treatment of acute phase of psychosis (schizophrenia and related
psychoses)
• Hospitalisation usually necessary
• Drug treatment for the psychosis
1 When oral medication possible, fi rst-line treatment is one of the
second generation antipsychotics:
• olanzapine 5–10 mg (o) nocte or
• risperidone 1 mg (o) nocte titrated gradually to 2–4 mg (o) bd
(beware hypotension) or
• quetiapine 50 mg (o) bd ↑ as tolerated to 200 mg bd (by day 5) or
other
2 When parenteral medication required:
• haloperidol 2.5–10 mg IV or IM, initially,↑ 20 mg in 24 h, depending
on response or
• zuclopenthixol acetate 50–150 mg IM as a single dose add
• benztropine 1–2 mg (o) bd (to avoid dystonic reaction)
If dystonic reaction:
• benztropine 1–2 mg IV or IM
If very agitated, use:
• diazepam 5–20 mg (o) or 5–10 mg IV
Chronic phase of schizophrenia Long-term antipsychotic medication
recommended to prevent relapse.
Examples of oral medication regimens:
• olanzapine 10–20 mg (o) nocte or
• quetiapine 150 mg (o) bd or
• risperidone 0.5–1 mg (o) bd, up to 2–4 mg (o) bd
Use depot preparations if compliance is a problem (use test dose fi rst):
• fl uphenazine decanoate 12.5–50 mg IM, every 2–4 wks or
• haloperidol decanoate 50–200 mg IM, every 4 wks or
• fl upenthixol decanoate 20–40 mg IM, every 2–4 wks or
• zuclopenthixol deconate 100–400 mg IM every 2–4 wks
Resistant schizophrenia (options)
• clozapine 12.5 mg (o) bd initially increasing up to 300–600 mg/d
• olanzapine 5–20 mg (o)/d