Psychotic symptoms related to mental and medical disorders can pose a medical 
emergency. Selecting an appropriate antipsychotic medication to treat this 
emergency is based on the clinical situation, preferred route of administration, 
pharmacokinetic profile of the antipsychotic and the medications currently being 
taken by the patient. Intramuscular preparations are usually preferred over oral 
medication when the patients are not co-operative and require drugs with a 
faster onset of action and good bioavailability. High potency antipsychotics 
such as haloperidol and fluphenazine are effective in stabilising patients with 
psychotic symptoms quickly. Loxapine is an alternative when sedation is 
necessary and molindone is useful if a short-acting antipsychotic is required. 
Rapid neuroleptisation with intramuscular preparations of antipsychotic achieves 
therapeutic drug concentrations more rapidly, and also provides optimal control 
of psychotic symptoms. If the patient is cooperative, liquid oral preparations 
can be used; they are as effective as intramuscular formulations. If long term 
treatment with an antipsychotic in necessary and patients are stabilised, they 
can be switched from intramuscular to oral preparations. The oral dose is 
usually 1.5 to 5 times the total intramuscular dose per day, based on the 
bioavailability of the antipsychotic medication. If the patient is currently 
taking antipsychotic medication when the emergency situation occurs, it is 
usually adequate to increase the dose of antipsychotic drug. Appropriate dose 
adjustment or antipsychotic selection is necessary when drug interactions are 
expected. An in-depth knowledge of the pharmacokinetic profile and drug 
interaction profile of antipsychotic in necessary for the selection of the 
appropriate antipsychotic for any given emergency situation.