Ethical issues in drug selection for schizophrenia

The introduction of neuroleptics over 40 years ago was a landmark in medical history. Although effective, antipsychotics have many side-effects, some severe. Because of the great needs in this therapeutic area, there has been a risk of viewing the introduction of new agents such as clozapine as panaceas. The true advantages of the new atypical neuroleptics need to be assessed realistically, by critically evaluating their effects on positive and negative symptomatology, potential adverse effects and cost benefit. Due in part to the toxic effects of neuroleptics, obtaining consent to treatment is fraught with complexities of a legal and ethical nature. However, despite the many burdensome aspects of this disease, including the high risk of suicide among patients, clinicians should foster patients insight and a collaborative approach to coping with schizophrenia.