The atypical antipsychotic drugs are a major advance in the treatment of psychosis in spite of concerns about metabolic and cardiovascular side effects that affect morbidity and mortality. Concerns about weight gain, hypoglycemia, diabetes, and increases in lipids as well as sudden death due to torsades de pointes and other cardiovascular events can temper enthusiasm about the atypical antipsychotics. The challenge for the clinician is to weigh the benefits and risks for each drug for each patient and develop a treatment plan with the individual patient in mind. This article discusses both risks and benefits of antipsychotic treatment and presents a treatment algorithm to aid the clinician in choosing medications for the psychotic patient.