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The overwhelming majority of patients with a chronic psycho-sis have one of the primary disorders, that is, schizophrenia, schizoaffective disorder or delusional disorder: secondary causes of psychosis are relatively uncommon.
This is determined by the underlying cause. For example, whereas a psychosis occurring secondary to a medication, such as a dopaminergic drug, generally clears within days of discon-tinuation of the drug, the psychosis due to a chronic condition, such as Huntingtonâ€™s disease, is likewise chronic.
Treatment, if possible, is directed at the underlying cause. In those cases where such treatment is unavailable or ineffec-tive, or where control of the psychosis is emergently required, neuroleptics are indicated. Although conventional neurolep-tics, such as haloperidol, have long been used successfully, newer atypical agents, such as olanzapine or risperidone, may be better tolerated. In general, it is best to start with a low dose (e.g., 2.5 mg of haloperidol, 5 mg olanzapine or 1 mg of risperidone) with incremental increases, if necessary, per-formed slowly.
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