[Neuroleptics in psychogeriatrics. A proposal for a more rational prescription policy]

All neuroleptics have a cerebral dopamine receptor blocking effect. This is the best documented explanation for their anti-psychotic effect. Furthermore, they act to a widely differing extent in a blocking manner to other central neurotransmitters, such as noradrenaline, acetylcholine, histamine, and serotonin. During the last couple of years quantitative data have been produced, enabling a more rational choice of neuroleptics. Based on these data and a number of pharmacokinetic considerations, a provisional scheme has been elaborated for the choice of neuroleptics in some clinical situations in psychogeriatrics. Our own experiences with this scheme are promising. It allowed us to restrict the use of neuroleptics to five drugs. The neuroleptics with a strong sedative and anticholinergic action, such as alimemazine, promazine and levomepromazine, being potentially dangerous to particularly elderly patients, are no longer used.