Conventional and atypical antipsychotics and the evolving standard of care

Novel or atypical antipsychotic medications appear to offer patients the benefits of conventional neuroleptics with lower risks of side effects, but the newer drugs cost much more than the older drugs. Many U.S. psychiatrists have concluded that the novel antipsychotic drugs should be first-line therapy and represent an emerging standard of care in treating psychoses. This view raises the question of whether doctors who prescribe the older, cheaper drugs are engaging in malpractice or violating patients' rights. The authors explore reasons why psychiatrists may continue treating some psychotic patients with conventional neuroleptics, despite the apparent advantages of novel antipsychotics. They also describe possible sources of liability that might arise from using conventional neuroleptics and examine how existing case law might bear on these matters. Recent data on antipsychotic prescription practices and court decisions issued through September 2000 suggest that proper use of the older drugs is not a deviation from the standard of care. However, case law suggests that psychiatrists have a legal obligation to tell patients about novel antipsychotic agents even if they continue to prescribe conventional neuroleptics.