Management of chronic psychotic ambulatory outpatients

The introduction of novel atypical antipsychotic medicines has raised new possibilities in the treatment of psychotic patients. In particular, the discovery of pharmacologic agents that may ameliorate the most stubborn positive and also negative symptoms without adding the burden of major side effects is revolutionizing treatment expectations. However, it is also becoming abundantly clear that successful treatment requires more than just the administration of a medicine. Treatment must also address the inner experiences of the patient, as well as the social and psychological handicaps that are associated with the illness. Some of the relatively neglected complications of using typical antipsychotic medicines include hyperprolactinemia and antipsychotics that may require concomitant treatment with anticholinergic agents, which themselves have an array of side effects. This article presents a detailed method for deciding when and how to use the new medications effectively and how to manage the transition from one medicine to another.