As I have described previously, I have been tracking my experience with tapering neuroleptic drugs in my clinical practice. With all of the people I see who are stable on a particular dose of a neuroleptic drug, I discuss the risks of long-term use of these drugs. We also discuss the potential benefits. This conversation varies from person to person. We take into account what has happened in the past, how he is doing now, and what she has to lose if her past problems were to re-emerge. If a person wants to taper, I suggest slow reduction; 25-30% every 3-6 months. I keep track of who chooses to taper and who does not. I now have a colleague who is doing the same in her practice. Together, we are following 112 individuals. We presented our data in a poster presentation at the Institute of Psychiatric Services in October, 2013.Read More
One of the first lessons I received as a psychiatrist-in-training 35 years ago was the value of antipsychotic medications. These medicines have been available for the treatment of psychosis for over half a century, beginning with the prototype first generation drug chlorpromazine (Thorazine) and now extending to some 20 different compounds, including several second-generation medications, often called “atypical antipsychotics.” Symptoms such as hallucinations, delusions, and paranoia are reduced reliably by these drugs. Although these symptoms can be frightening and dangerous for patients, family members, and providers, antipsychotics safely and effectively help people through the crisis of acute psychosis.
However, the long-term management of chronic mental illness is another matter. Recently, results from several studies have suggested that these medications may be less effective for the outcomes that matter most to people with serious mental illness: a full return to well-being and a productive place in society.Read More
Importance The increased prescribing of antipsychotics for children and youth has heightened concerns that this practice increases the risk of type 2 diabetes mellitus.
Objective To compare the risk of type 2 diabetes in children and youth 6 to 24 years of age for recent initiators of antipsychotic drugs vs propensity score–matched controls who had recently initiated another psychotropic medication.Read More