What is the first-line treatment for acute psychosis?

• A. Antipsychotics
• B. Mood stabilizers
• C. Benzodiazepines
• D. Selective serotonin reuptake inhibitors

Answer: (C)

Acute psychosis is treated first with an antipsychotic because these medications directly target the core symptoms—delusions, hallucinations, and disorganized thinking—by reducing the abnormal dopaminergic activity that underlies the psychotic process. This helps stabilize thinking and perception quickly, which is essential for safety and recovery in the acute setting.

Benzodiazepines can be useful briefly to calm agitation or anxiety and to aid sleep during initial stabilization, but they do not treat the underlying psychosis. Relying on them as the primary treatment risks oversedation, respiratory depression, and cognitive impairment, and they don’t address the cause of the psychotic symptoms.

Mood stabilizers and SSRIs target mood disorders or depressive symptoms and are not appropriate as first-line therapy for an acute psychotic episode unless a concurrent mood disorder requiring those agents is present. In acute care, the emphasis is on an antipsychotic to control symptoms, with careful assessment for safety and contributing factors (substance use, medical causes) and consideration of adjunctive benzodiazepines only as short-term support when indicated.