High-dose antipsychotic medication.

The dopamine hypothesis for the mode of action of antipsychotic drugs has been with us for some 30 years and has, by and large, withstood the test of time. It simply states that antipsychotic drugs owe their therapeutic effects to an ability to block central dopamine receptors. This has given us a working and testable explanation for the effects of these drugs and it has prompted the synthesis of new agents. While so-called antipsychotic drugs (other wise known as neuroleptics or major tranquillisers) are known to be effective in schizophrenia and related psychoses, mania, and the agitation asso ciated with severe depressive illness or organic disorder, this paper is only concerned with the pharmacotherapy of schizophrenia. Expose the brains of patients suffering from schizophrenic illness to a D2 dopamine receptor blocker, and in 7 cases out of 10 there will be a useful amelioration of positive psychotic symptoms, usually within two months. What do we do about the 3 out of 10 who do not get better? Most clinicians edge the dose of antipsychotic medication up sometimes past the point at which Parkinsonian signs become prominent, and