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Neuroleptics

Neuroleptics are all substances with an antipsychotic effect, i.e. drugs that are used against states of excitement, delusional ideas, hallucinations, mental experience and other (e.g. catatonic) disorders of experience or behavior.

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The so-called "highly potent" neuroleptics have a strong effect and reduce the intensity of perception. This affects sensory perceptions just as much as the perception of one's own body, thoughts and feelings. When the effect is pronounced, you feel dazed, cut off from the world and from yourself, as if you were "not really there".

This neuroleptic effect is useful in many cases because it breaks through the state of acute overload and overwork, which is particularly associated with acute psychoses. Under the influence of the drug it becomes easier to test psychotic experience for its reality content, and one can gradually find one's way back to general reality.

Shielding effect

However, the shielding effect is usually not perceived as pleasant, but merely as useful - better than the psychosis. This has the advantage that with neuroleptics - just like with antidepressants - there is no risk of addiction or dependence.

The disadvantage, however, is that some of those affected reject the shielding of the entire perception, especially if it is subjectively very pronounced, and are very reluctant or not at all ready to take the neuroleptic, even if it is associated with an increased risk of renewed psychosis can. A good cooperation with the treating specialist can in most cases lead to a generally acceptable prescription.

Support from relatives

As a relative, you can be an important support in this, even if several attempts are required - the first prescription does not always have to be the best! If patients are forced or compelled to take a subjectively unpleasant drug, the willingness to cooperate with doctors and other psychiatric services may be disturbed in the long term. In addition to acute treatment, neuroleptics are also used for long-term treatment or prevention. Here, too, they can be very useful, in many cases even indispensable.

Supplements to psychiatric drugs

In view of the unpleasant effect and the sometimes serious side effects, long-term use should be well justified, supplements and alternatives such as psychotherapy, family counseling, rehabilitation and the various community psychiatric aids should be included. If it is possible to stabilize sufficiently psychologically and socially over time, the need for further neuroleptic treatment should be checked again and again at longer intervals.

Depot syringes

For long-term use there are many neuroleptics - in addition to tablets or drops for oral use - as depot syringes for intramuscular injection. The individual syringe works for one or more weeks, depending on the preparation, so that only one injection at these intervals is required for treatment. Those who find daily tablet intake annoying can choose the depot syringe as an alternative. However, with this dosage form, the concentrations of the substances in the body, the so-called "blood levels", usually fluctuate more than with tablets. Because of this, more side effects may occur in the first few days after the injection, or shortly before the next injection appointment, the neuroleptic shielding may be inadequate. The patient and doctor should then agree on an adjustment of the prescription or switch to tablets, possibly with the support of relatives.

"Weak or low-potency" substances

While the "highly potent" neuroleptics have above all the antipsychotic-shielding effect described, the so-called "weak or low potent" substances are mainly effective in a depressant (sedative) manner: They slow down all psychological processes, reduce self-drive and make you tired. Similar to sedating antidepressants, they can therefore be used (even in non-psychotic states of restlessness or sleep disorders) for general calming and to promote sleep, also in combination with highly potent neuroleptics.

Between the high and low potency there is the group of "medium potency" neuroleptics, which in addition to the less strong shielding also have a certain sedating effect. Their antipsychotic effect is sufficient in many cases, except in the case of pronounced psychotic experience. You can see below which substance belongs to which of these groups. (...)

Reduce and stop taking neuroleptics

For many people with psychotic illnesses, taking neuroleptics takes years, because they can help prevent or at least alleviate recurrence of psychoses even after the acute symptoms have subsided. Whether this prevention is actually still necessary should be checked at longer intervals.

Neuroleptics can cause many side effects, some of them serious. Therefore, attempts to reduce the dose or to end neuroleptic treatment that is no longer required are an essential part of careful handling of this group of drugs. The most important prerequisites for reducing or discontinuing neuroleptics, however, are sufficient psychological stability and a stable living situation. Anyone who is constantly struggling with the flare-up of psychotic experiences will usually not benefit from a dose reduction or discontinuation.

In small steps

It is recommended to proceed in small steps: The current dose should only be reduced slightly so that the difference is barely noticeable. Then it would be necessary to observe over at least a few weeks whether the new dose is sufficient before taking the next step. If there is an increase in restlessness, sleep disorders or other (pre-) psychotic early warning signs, a temporary increase in the dose is advisable. In this way you can clarify whether and possibly in what dose you should still take the neuroleptic in order to maintain sufficient psychological stability. However, this requires some patience and, if possible, a good understanding between the patient, the most important people in his environment and the treating doctor.

Neuroleptics in detail

In order to give you an initial orientation about the common neuroleptics, we will give you the substances and (in brackets) the best-known brand names below. Preparations that are also available as a depot for injection are in italics. There is no rating associated with the alphabetical order.

Highly potent neuroleptics: strongly shielding (antipsychotic), hardly dampening

Benperidol (Glianimon®), Bromperidol (Impromen®), Fluphenazine (Dapotum®, Lyogen®), Flupentixol (Fluanxol®), Fluspirilen (Imap®), Haloperidol (Haldol®)

Moderately potent neuroleptics: shielding and dampening

Perazin (Taxilan®), Perphenazin (Decentan®), Pimozid (Orap®), Zuclopenthixol (Ciatyl-Z®)

Weakly potent neuroleptics: mainly depressant

Chlorprothixen (Truxal®), Levomepromazine (Neurocil®), Melperon (Eunerpan®), Pipamperon (Dipiperon®), Promethazine (Atosil®), Thioridazine (Melleril®)

literature

  • Aderhold, V .; Schlimme, J .; Weinmann, S. (2018): Reduction and withdrawal of antipsychotics (from: Kerbe 2/2018) download as PDF file
  • Aderhold, V. (2014): Neuroleptics minimal - why and how. Download article as PDF file.
  • Bandelow, B .; Bleich, S .; Kropp, S. (2012): Handbuch Psychopharmaka. Hogrefe Verlag, 3rd edition.
  • Benkert, O .; Hippius, H. (2013): Compendium of Psychiatric Pharmacotherapy. Springer Verlag, 9th edition.
  • German Society for Social Psychiatry (2012): Memorandum of the German Society for Social Psychiatry on the use of neuroleptics. Download the brochure as a PDF file.
  • German Society for Social Psychiatry (2014): Reduce and discontinue neuroleptics. A brochure for people with psychosis, relatives and professionals of all professions. Download the brochure as a PDF file.
  • Finzen, A .; Scherk, H .; Weinmann, S. (2017): Drug treatment for mental disorders - guidelines for everyday psychiatric life. Psychiatry Publishing House.
  • State Association of Psychiatry Experienced Rhineland-Palatinate e.V .: Download information sheets for antipsychotics as a PDF file
  • State Association of Psychiatry Experienced Rhineland-Palatinate e.V: Download information sheets for antipsychotics in easy language as a PDF file
  • Lehmann, P; Aderhold, V .; Rufer, M .; Zehentbauer, J .: New Antidepressants, Atypical Neuroleptics - Risks, Placebo Effects, Low Doses and Alternatives. With an excursus on the recurrence of electric shock. Forewords by Andreas Heinz as well as Peter Ansari and Sabine Ansari, afterword by Marina Langfeldt. Berlin and Shrewsbury: Peter Lehmann Publishing 2017
  • Weinmann, S (2012): Success myth of psychotropic drugs - Why we have to reassess drugs in psychiatry (eBook). Psychiatry Publishing House.

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