Citation

Miller R. Curr. Neuropharmacol. 2009; 7(4): 315-330.

Affiliation

Otago Centre for Theoretical Studies in Psychiatry and Neuroscience (OCTSPAN), Department of Anatomy and Structural Biology, School of Medical Sciences, University of Otago, P.O.Box 913, Dunedin, New Zealand.

Copyright

(Copyright © 2009, Bentham Science Publishers)

DOI

10.2174/157015909790031184

PMID

20514211

PMCID

PMC2811865

Abstract

Rapid-onset psychotic rebound is uncommon on discontinuation of most antipsychotic drugs, as might be expected for antipsychotic drugs with (hypothetically) indirect actions at their final target receptors. Rapid-onset psychosis is more common on withdrawal of clozapine, which might be expected if its action is direct. Drugs other than clozapine (notably thioridazine) may have hitherto unrecognised similarities to clozapine (but without danger of agranulocytosis), and may be useful in treatment of refractory psychosis. Quetiapine fulfils only some criteria for a clozapine-like drug. Clinical response to neuroleptics varies widely at any given plasma level. Haase's "neuroleptic threshold" concept suggests that the dose producing the slightest motor side effects produces most or all of the therapeutic benefit, but analyses presented here suggest that antipsychotic actions are not subject to a sharp "all-or-none" threshold but increase over a small dose range. This concept could provide a method for quantitative determination of individualized optimal doses.

Language: en