Maintenance medication for chronic schizophrenics: risk/benefit assessment

The following are key factors to consider in assessing a patient for long-term neuroleptics: 1. Who--accurate diagnosis of schizophrenia is of primary concern. There are no good prognostic indicators other than a history of repeated relapses and positive responses to neuroleptics. 2. When and for how long--should always be considered for the patient who has had more than two acute episodes. The first year post-acute episode back in the community is extremely critical. Consider maintaining patient on tapering dosage of medication for at least four to five years. 3. What benefits--symptoms of acute psychosis respond, those of chronic defect state do not. Medication also can act as buffer against stress. 4. Dosages--standard range is the equivalent of 300-800 mg. of Thorazine for most patients. Dose range for depot administration of Prolixin decanoate is 25-62.5 mg. 2-4 week intervals. Differences within this range may not be important. Data about very low doses (one-tenth standard dose) and megadoses (4-5 times standard dose) are inconsistent. 5. Risks--extrapyramidal symptoms, tardive dyskinesia, and akinetic depression are the most prevalent risks. Extrapyramidal symptoms can often be controlled effectively with dosage reduction. However, anticholinergic drugs are the treatment of choice during acute phases, and for the first 3-5 months post-acute phase. Tardive dyskinesia rarely occurs after a few weeks or months, but occurs most commonly beginning after two years of drug treatment. The usual form is persistent, but transient forms also occur. The earliest signs are reversible in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)