THE STATUS QUO OF PSYCHIATRIC DRUGS

Maintenance phenothiazine therapy does prevent relapses of schizophrenia SchizophreniCs of intermediate prognosis living in the community relapse much less often on maintenance phenothiazine therapy than ofT'it. Like epilepsy, schizophrenia is a disease with symptoms that can be suppressed only as long as medication is taken, Schizophrenics do much better when their families accept them and are less critical of their problems, In these patients extremely high doses of phenothiazines tend to be unnecessary, A trial withdrawal of neuroleptics every few years in chronic schizophrenics in hospital is justified, In patients with personality disorders, chronic neurosis, or brain damage, long term phenothiazines may be toxic and are of dubious benefit, Recently, it has been suggested that interrupted, rather than continuous courses of phenothiazines may hasten the development of tardive dyskinesia by kindling hypersensitivity in dopamine receptors. If this is so, then the practice of 'drug holidays' may be wrong, 1M depot phenothiazine preparations have emerged to prevent patient non-compliance.

High dose chlorpromazine and thioridazine, which can cause pigment deposits in retina, optic lens, heart and skin, and

gynaecomastia in men, can be replaced by 1M depot phenothiazines,

Antiparkinson drugs may be more bane than boon: Another recent refinement in neuroleptic prescribing has been the realisation that antiparkinson drugs may not be necessary , In fact, antiparkinson drugs may reduce the efficacy of neuroleptics, aggravate tardive dyskinesia, and potentiate autonomic disturbances, As the prevalence of tremor, rigidity, restlessness and posturing is unacceptably high in most studies, there appears to be a need to find the minimum effective dose of a neuroleptic with

the least side effects,

Lithium t,herap~ remains ~igh~y efficacious and rel.atively safe: Uninterrupted lithium therapy provides highly effective prophylaxis for bIpolar affectIve disorders, recurrent mama and recurrent depression The results of the MRC t ' I ' ffi ,.. . ,. . ' . na companng the e lcacy.of amltr~ptYlIne a~d lIthIUm m recurrent depreSSIOn are forthcoming. Lithium is often preferable to phenothiazines in p~eventmg CY~IOId and schlzoa~ective psychoses , Although the literature suggests that long term lithium therapy may affect kidney, thyrOid, and bone functIOn, these are usually remediable. The Worid Psychiatric Associatl'on conc'luu'eo" , ,.."',.. -' .. .. , " , III I ~ I ~ Ula( me

nsk of .se~lous .progresslble renal da~~ge due to li~hium was very slight. Nephrogenic diabetes insipidus is a nuisance, but abates w~en IIthlU~ IS stopped, ~y~thyrOld~sm: ~ound 10 less than 5 % of lithium-treated patients, responds adequately to thyroxin. As ammal studies show that lithIUm may mhlbIt bone and tissue growth , there may be some reservations about . l'th ' . h

'ld usmg I lUm In c I reno

Two long term follow-up studies provide therapeutic optimism: In 1976, it was shown that mortality from all 'all "d d' . causes,

espec~ y SUlCI . e an ~r~lOvascular disease, was much less in depressives treated with adequate doses of tricyclic antidepressants than m depresSIves recelvmg no treatment or inadequate doses, In another study in 1979 the same pattern of mortality was . rth' , ,seen !D I lUm-treated manic-depressives as in manic-depressives in general , and there was no evidence that chronic toxicity was a cause of death,

'Besides keeping ourselves up to date on the known advantages and disadvan­tages of maintenance therapy, ' . ,there is an equal obligation to keep patients in­formed so that 'compliance' is really informed choice.'

Ke!!!!~y, P.: British JO:\1Irn.1 of Psychiatry 137: 387 (Oct 1980)

0156~2703/81/0110-0003 $00.50/0 C AOIS Press lNPHARMA 10 Jan 1981 3