The need for vigilance

Although they are not curative agents, the beneficial effects of antipsychotics on the severest end of the psychiatric spectrum have been established unequivocally. These drugs have been the catalysts for reversing centuries-old misconceptions of madness, both lay and professional, and the tools which have made possible the implementation of humane models of care for some of the most vulnerable and misunderstood of human beings. It would be hard to over-emphasise their impact. Like all medical interventions, however, their target actions (the benefits) only come as part of a package, which includes a variety of non-target actions (the adverse effects), and while the latter issues are the primary concern of the present volume, the reader must place them in the above context.

The major impact of drug-related movement disorders is within psychiatric practice, and indeed psychiatry has more or less ‘phagocytosed’ the idea of EPS as its own. In terms of volume, this is justified. In no other area of medicine have therapeutic tools so crucial to practice produced such high levels of iatrogenic neurological morbidity. Any psychiatric unit and its environs provide a rich observatory of the range of ills to which the human extrapyramidal system can fall prey, and any group of people anywhere on earth may hold an example for the keen eye.

The author vividly recalls a trip to South West Java, which, although geographically close to Jakarta, remains isolated and traditional.