The choice of neuroleptics in the treatment of schizophrenia: a critical review

The selective use of different neuroleptics in the treatment of schizophrenia by some psychiatrist according to the greater need for a sedative, antidelusional or activating effect is supported only by some uncontrolled clinical observations. Most extensive controlled studies done until now showed no significant differences among neuroloptics in their therapeutic efficacy. The hypothesis that these drugs have specific and selective actions therfore cannot be accepted. In the single patient it seems more rational to choose the right dosage schedule instead of the "right drug". Though the study of the metabolism of these drugs remains the most interesting approach to the problem of the individualization of the therapy., the results of these studies have until now been disappointing e.g. plasma levels of chlorpromazine correlated weakly with clinical improvement. In clinical practice an important element in the process of choosing is still the incidence of side effects and in fact at the moment "the drug of choice" can only be the drug best tolerated by the patient.