Psychiatric patients in the emergency department (ED) present unique and difficult challenges for the emergency medicine physician. This chapter reviews current therapies, as well as newer and investigational treatment options useful to diminish acute psychiatric symptoms. All ED staff involved in the use of restraints must be well versed in criteria for use of restraints and their proper and appropriate application. The most used typical antipsychotics in the ED for rapid lysis of acute psychosis have been haloperidol (Haldol) and droperidol (Inapsine). The atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon) have a pharmacologic profile that is favorable. An agent that would provide the acute lysis of suicide thoughts and provide for a cooling off period for patients while they achieve therapeutic benefit from antidepressant therapy and receive outpatient therapy would be quite useful in the ED setting.