Tranquillizers

The last ten years have seen the introduction of many new drugs for the treatme' of psychotic disorders and practically every psychiatric symptom. They are alreat replacing the barbiturates which have been used as sedatives for over 50 years. These drugs aim at influencing the processes concerned in the development of psychiatric illness, e.g. schizophrenia and depression, or at controlling the mo' disturbing phenomena such as agitation, anxiety, or tension. The sedatives, and particularly barbiturates, have a hypnotic and functional depressing effect in proportion to their potency and their action is mainly on high cerebral function. Many of the new drugs have no hypnotic effect. Some cause creased alertness and may produce extra-pyramidal disturbances and other evidefl' of an action on the reticular system and deeper structures of the brain. It must' stated however, that in spite of the theoretical neuro-pharmacology, there is no co< elusive evidence about how they influence the production of mental symptoms, even less about how their action may be related to a neuro-physiological origin' psychosis. Even in the group of mono-amine-oxidase inhibitors, the theory th psychosis is influenced by their effect upon certain enzyme systems in the brain completely unproven and it has been suggested that this action is totally irrelevant! indeed it takes place in humans. Nevertheless, it is established that these drugs do relieve certain psychiatric illness; and it is possible, even at this early stage, to say what the indications are and how si' effects and undesirable complications can be minimized. The first of these drugs to be introduced was Chlorpromazine which was call' rather erroneously a tranquillizer because it calmed agitation, restlessness, and psych' tic behaviour, but the name suggested that it produced mental tranquillity which quite a different matter. This has been responsible for much of the inappropri^ use of the Promazine drugs. Chlorpromazine had its early striking success in tl treatment of disturbed, hallucinated patients in the long-stay wards of large men* hospitals and not in tranquillizing anxious individuals in the community. The drugs can conveniently be divided into three groups: the so-called tranquillize' mainly useful for psychotic disturbances and agitation; the thymoleptics for depressio' and an indeterminate group partaking of both the tranquillizer and the thymolep1 effect. The effect of these drugs in psychotic patients is not necessarily the same as in nof psychotics. This should be borne in mind when prescribing. Failure to realize tb: the response …