Management of Chronic Psychotic Ambulatory Outpatients

The introduction of novel atypical antipsychotic medicines has raised new possibilities in the treatmentof psychotic patients. In particular, the discovery of pharmacologic agents that may amelioratethe most stubborn positive and also negative symptoms without adding the burden of major side effectsis revolutionizing treatment expectations. However, it is also becoming abundantly clear thatsuccessful treatment requires more than just the administration of a medicine. Treatment must alsoaddress the inner experiences of the patient, as well as the social and psychological handicaps that areassociated with the illness. Some of the relatively neglected complications of using typical antipsychoticmedicines include hyperprolactinemia and antipsychotics that may require concomitant treatmentwith anticholinergic agents, which themselves have an array of side effects. This article presentsa detailed method for deciding when and how to use the new medications effectively and how to managethe transition from one medicine to another.