Neuroleptic drugs in the treatment of acute psychosis: how much do we really know?
The efficacy of neuroleptic antipsychotic drugs has been well demonstrated and neuroleptics are the standard treatment of acute psychosis. However, important aspects of neuroleptic treatment, including course of response, optimal doses, and mechanism of action, remain poorly studied or controversial. Placebo-controlled studies of the onset of the response of acute psychosis to neuroleptics are few and yield conflicting results. Studies of the relationship of doses and blood levels to the therapeutic effects of neuroleptics suggest that the optimal range of doses and levels is narrow and that commonly used doses are too high. Finally, studies of the mechanism of action of neuroleptics suggest that the dopamine hypothesis is based on unsupported assumptions concerning drug effects, drug distribution, and effective doses of drug. Alternative hypotheses, that the antipsychotic effects of the neuroleptics are mediated, at least in part, through alpha 1-adrenergic or serotonin 5-HT2 receptor antagonism, are reviewed. The evidence regarding these issues and controversies is discussed, and specific approaches to increase our understanding and enhance our use of the neuroleptics are suggested.
D000208:Acute Disease; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D006801:Humans; D011618:Psychotic Disorders / Q000188:drug therapy*
D014150:Antipsychotic Agents