[Amisulpride, a one-of-a-kind and highly efficacious antipsychotic agent in the treatment of first-episode psychosis]. 
In this commentary we discuss the findings of the recently published OPTiMiSE trial.  In terms of design, important advantages of the trial are the naturalistic, open label set-up that allowed the authors to assess the efficacy of the sequential use of amisulpride followed by olanzapine and clozapine.  In terms of results, we highlight the efficacy of amisulpride, while we disagree with the authors of OPTiMiSE when they claim clozapine should be tried in the clinic after one unsuccessful trial of amisulpride.  We also show how the actual percentages of those complaining of sexual side effects during amisulpride use are higher than computed by the authors.  On a general note, we suggest that whenever symptoms of patients allow it - and gradual improvement is observed - clinicians may wish to wait several weeks before considering a switch to amisulpride.