Abstract
The release of the antipsychotic agents risperidone, sertindole and olanzepine forces difficult choices upon clinicians. The new compounds are better tolerated than neuroleptics, expensive and their long-term side-effects unknown. These choices can be made easier by the dose and side-effect minimisation procedure set out below, which aims to produce the greatest benefit and least harm from conventional neuroleptics.
Highlights
That sensitivity to medication varies during the course of the disease seems to have been ignored, it is clinically often observed that acutely psychotic patients can be remarkably tolerant of high doses of neuroleptic drugs
The method used by many of the clinicians who trained me was to increase a neuroleptic until the patient began to improve, the British National Formulary dose limit was reached, their sedation was satisfactory or move ment disorders could not be contained with anticholinergic medication
Anticholinergic medication is often required at this stage but delaying morning doses allows side-effects to be examined to determine if the neuroleptic threshold has been regained
Summary
The release of the antipsychotic agents risperidone, sertindole and olanzepine forces difficult choices upon clinicians. That sensitivity to medication varies during the course of the disease seems to have been ignored, it is clinically often observed that acutely psychotic patients (a group relatively little researched) can be remarkably tolerant of high doses of neuroleptic drugs. The method used by many of the clinicians who trained me (and 1 assume many readers) was to increase a neuroleptic until the patient began to improve, the British National Formulary dose limit was reached, their sedation was satisfactory or move ment disorders could not be contained with anticholinergic medication. Anticholinergic medication is often required at this stage but delaying morning doses allows side-effects to be examined to determine if the neuroleptic threshold has been regained. Their illness, current symptoms and previous response to neuroleptics Discuss with patient their treatment preferences and the likely side-effects of medication. Note restlessness, increased tone, cogwheel rigidity, stiffness or akinesia (modified from McEvoy et al 1986)
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