Short-term inpatient pharmacotherapy of schizophrenia

There is much practice variation in the pharmacotherapy of schizophrenia on short-term acute inpatient units, where the length of stay may be 1 week or less. We surveyed relevant practice guidelines, review articles, and individual studies and developed summary statements regarding evidence-supported procedures for short-term inpatient stabilization. If the patient requires parenteral treatment, the combination of intramuscular haloperidol 2-5 mg and lorazepam has the earliest effect. For initial oral treatment, monotherapy with one of the new "atypical" antipsychotics is favored. Some evidence suggests that risperidone may have an earlier onset of action. Olanzapine seems to have a relatively more rapid effect when started at a daily dose of 15 mg, rather than 5 or 10 mg. The role of quetiapine is somewhat unclear. In the event of nonresponse to the initial antipsychotic after 3-7 days, alternatives may include increasing the dose, switching to a different antipsychotic, or adding a mood stabilizer.