[Aspects of long-term therapy using long-term neuroleptics -- experiences and viewpoints related to practice]

Practical aspects of long-term neuroleptic therapy are discussed in the light of the author's own experience and observations; reference is made to the relevant literature. The author looks at the terms "sociogenic" and "somatogenic" in the context of treatment of schizophrenia and finds them to be not so antithetic as has traditionally been supposed. He describes the advantages and disadvantages of long-term neuroleptic therapy, both oral and injectable. He analyses the starting of a rational long-term therapy in the light of various factors. He examines the effective spectra of the traditional long-term neuroleptica and finds little justification for the different specific indications claimed for the various drugs. On the example of selected patients suitable for this therapy he considers the causes of the disorders and the primary personality and early development of the subjects, discussing the nature of the illness from the nosological and clinical point of view, the social and economic situations, the type of follow-up, and the physician-patient relationship. Emphasis is laid on the significance of side-effects and of individual reactions to long-term neuroleptics. The questions how, when and where a patient should be put onto long-term medication are treated, with a critical comparison of high and traditional doses, and a recommendation that duration and stoppage of therapy be decided on the basis of individual case factors. Special attention is paid to the so-called pharmacogenic depressions. Other indications of long-term neuroleptic therapy are mentioned. The author considers the integration of pharmaco-therapy into a complex rehabilitation program to be essential; without this there can be no progress in the treatment of schizophrenia.