Optimising medication

We have argued in previous chapters that psychotic symptoms that are untreated or that do not respond adequately to treatment increase stigma, since such symptoms reinforce the public's stereotype of the mentally ill person. Additionally, both positive and negative symptoms interfere with the user's ability to engage in work and social activities. The first line of treatment is pharmacological, but this has its own deleterious effects on users' functioning. The most disabling side effects of conventional antipsychotic drugs are parkinsonism, sedation and sluggish thinking. The parkinsonian effects result from blocking of the dopamine-2 receptors in the basal ganglia of the brain. The new-generation antipsychotic drugs have a different pattern of action. They block the effect of dopamine for much briefer periods of time than the standard antipsychotic drugs (Kapur and Seeman, 2001) and they also have a blocking action on the effect of the neurotransmitter serotonin (Sartorius et al., 2002).

The most effective of the so-called atypical antipsychotics is clozapine, but this has the potentially lethal effect of suppressing white cells in about 1% of the people receiving it. Therefore, it is essential to test the blood regularly in clozapine users to check the number of white cells. Some clozapine users refuse to have their blood tested, meaning that they should not take this drug. Other atypical antipsychotics in common use include risperidone, olanzapine and amisulpride. The blocking effect of risperidone on dopamine-2 receptors increases substantially at higher doses, so it is advisable to keep the dose low.