Acute psychosis may be treated with oral medication given three or four times daily. There is a calming effect from the start, but control of delusions and hallucinations may take 3-4 weeks, and sometimes the full benefit is not seen for 6-12 months. In schizophrenia, the positive symptoms respond better than the negative ones. A recently introduced, medium-acting intramuscular preparation, Clopixol Acuphase, which exerts its effects over 2-3 days, is useful in very disturbed patients.

Chronic schizophrenia is often treated by slow-release, intramuscular injections (depots) every 1-4 weeks. Such injections may have a pharmacological advantage for some patients in whom oral medication is incompletely absorbed or undergoes rapid first-pass metabolism in the liver, but their main advantage is ensuring regular medication and follow-up for a group of patients whose compliance with oral treatment tends to be poor.

For some cases of schizophrenia that do not respond to conventional doses of drugs, clozapine should be considered at an early stage, as responses to this drug are seen that do not seem to occur with other agents. High-dose regimens are much less commonly used nowadays, especially since the advent of clozapine. In patients with treatment-resistant psychosis, it is better to add a drug from another class, usually a benzodiazepine, or consider ECT.

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