Schizophrenia and antipsychotic drugs

A variety of effective drugs are available for the treatment of schizophrenia. Knowledge of the side-effect spectrum of the various classes of antipsychotic drugs is necessary for the clinician to arrive at a rational choice of medication. In general, the preferred drug will be a high-potency neuroleptic. The following basic principles of clinical psychopharmacology should be followed: Consider risk and benefits; clinical experience is prerequisite; establish the diagnosis; select the appropriate class of psychotropic drug for the primary diagnosis; within drug class, the drugs are usually equally effective for patients with the diagnosis; give a dose that is high enough to be effective; choose target symptoms that can be monitored to indicate when to stop or increase the drug; avoid use of multiple drugs when possible; drugs are only one element in a comprehensive treatment strategy. Other modalities need equally careful consideration, e.g., psychotherapy, group therapy, family treatment, and vocational rehabilitation; and consultation with other subspecialists should be sought readily when indicated.