A Guide to Minimal Use of Neuroleptics

This guide provides a comprehensive review of antipsychotics, and an evidence-based rationale for treating first-episode patients without immediate use of antipsychotics; for prescribing antipsychotics at low doses when they are needed; and for supporting patients who want to taper from antipsychotic medication.

Authors: V. Aderhold, Institute for Social Psychiatry at the University of Greifswald, Germany;  P. Stastny, Department of Epidemiology, Columbia University, New York

2 COMMENTS

  1. Interesting article. I still have to digest it. I always strive to lower APs by titrating the dose by checking for cogwheeling (was not able to do this in my last job in corrections due to safety concerns). I am not a fan of Haldol 20 mg bid and cogentin 3mg bid doses of the patients I have inherited. However many of the patients I treated have very severe schizophrenia. They have history of substance abuse, TBI, self-injurious behavior and ASPD (all common in high-security prison psychiatric inpatient pod with death row offenders). Anytime I decrease their antipsychotics (i.e. from 20 mg haldol to 17.5 mg) many will report an increase in symptoms or exhibit increasing thought disorganization. Low dosing maybe theoretically attractive but does it translate to real world settings with those with SMI complicated by other factors? Also there are neuro-protective factors with APs as in https://www.mdedge.com/psychiatry/article/76283/schizophrenia-other-psychotic-disorders/beyond-dopamine-other-effects .

    • Have you read “Anatomy of an Epidemic”? Read the part about neurological up- and down-regulation and the impact it has on trying to withdraw from these drugs. The fact that people have a bad reaction to withdrawal doesn’t mean they “need these drugs.” It could mean that their brains have adapted, just as brains adapt to cocaine and meth and heroin, and that withdrawal effects occur when the drug is discontinued.

      Anyway, you really should read the book. That’s what this whole website is based on.