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December 23, 1974

Acute Psychosis

JAMA. 1974;230(12):1634. doi:10.1001/jama.1974.03240120016005

To the Editor.—  Anderson and Kuehnle (229:1884, 1974) presented an excellent protocol for vigorous psychopharmacologic and community care of acute psychosis. I have three additional sets of practical suggestions.The authors caution against depot fluphenazine; I, however, view fluphenazine decanoate as the drug of choice for community management. Complete noncompliance with pilltaking is generally set at 25% to 50% of all outpatients.1 Noncompliance among disorganized or paranoid psychotics must be even greater. A further advantage of depot fluphenazine in community management is that it relieves the family of the responsibility of having to coax or coerce pilltaking by the disturbed family member. I have personally adminstered more than 500 injections in emergency rooms, community clinics, and on home visits. I have never seen a significant local reaction or an allergic reaction. In the interests of dignity, I always give deltoid injections. The initial dose is 0.25 to 1 ml.