THE DISCUSSANTS REPLY
As described by Lawn, neuroleptic drugs can exacerbate parkinsonian symptoms. In the Case Record that we discussed, the physicians who were involved in the care of the patient carefully considered this potential complication. The patient’s severe behavioral disturbance led to the cautious use of neuroleptic drugs. Space constraints precluded further discussion of the challenges involved in behavioral treatment of this patient and the multiple alternative medications that had been tried. Similarly, Lawn’s comment that quetiapine and clozapine have fewer extrapyramidal side effects than other antipsychotic drugs is also well accepted. However, in the patient with severe agitation who is a potential threat to himself and others, when these agents (usually considered first-line) fail, there is little empirical evidence to guide the subsequent choice of antipsychotic medications.
Footnotes
Since publication of their article, the authors report no further potential conflict of interest.
Contributor Information
Bruce L. Miller, University of California, San Francisco, San Francisco, CA
Bradford C. Dickerson, Massachusetts General Hospital, Boston, MA