Which medications in the drug class Atypical antipsychotics are used in the treatment of Delirium, Dementia, and Amnesia in Emergency Medicine?

Updated: Sep 19, 2018
  • Author: Richard D Shin, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Atypical antipsychotics

These are newer neuroleptics with a lowered risk of extrapyramidal syndrome (EPS) and improved efficacy for the negative symptoms (eg, withdrawal, apathy) of psychosis because of their enhanced serotonergic activity as compared to older-style neuroleptics. These medications have largely supplanted older neuroleptics for sedation and treatment of psychosis in elderly patients with dementia.


Indicated for acute behavioral control in setting of acute psychosis, delirium, and as "chemical restraint." Less likely to cause severe dystonic reactions in younger patients than haloperidol and droperidol.

Risperidone (Risperdal)

Often used for sundowning in elderly patients but can increase mortality rate in dementia. Binds to dopamine D2 receptor with 20 times lower affinity than for serotonin 5-HT2 receptor. Improves negative symptoms of psychoses and reduces incidence of EPS. Also may have antidepressant effects, probably because of its serotonin activity.

Olanzapine (Zyprexa, Zyprexa Relprevv, Zyprexa Zydis)

Atypical antipsychotic that can be used for acute agitation. A prospective observational study revealed IM Olanzapine resulted in a greater proportion of patients adequately sedated at 15 minutes compared with IM haloperidol 5 mg, IM haloperidol 10 mg, and IM ziprasidone.

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