ABSTRACT
Since the patient is displaying psychotic symptoms, it is reasonable to consider an oral antipsychotic drug as first-line treatment.
• Historically, haloperidol has been the antipsychotic of choice in acutely disturbed behaviour. Up to 15 mg of haloperidol may be given orally in divided doses. However, in recent years the atypical antipsychotic olanzapine has been licensed for use in the management of the acutely disturbed patient. Up to 20 mg of olanzapine may be given orally daily in divided doses. Olanzapine has the advantage over haloperidol of being available as an orodispersible formulation ('velotab'), which is easier to take and more difficult to spit out than conventional tablets. Olanzapine also has the advantage over haloperidol as being less likely to cause both extra-pyramidal side-effects (EPSE) and prolongation of the QTC interval. Thus, olanzapine may now be considered to be the antipsychotic drug of choice in the management of the acutely disturbed patient.
