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Rapid response to:

Editorials

Are older antipsychotic drugs obsolete?

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7554.1346 (Published 08 June 2006) Cite this as: BMJ 2006;332:1346

Rapid Response:

pregnancy and schizophrenia

Dear editor
I fully concur with professor Ganguli's editorial that older
antipsychotics have not become obsolete. I would like to discuss about
pregnancy in people with schizophrenia,a vulnerable group of patients.

Pregnancy is a life event which can provoke worsening of mental
status especially in younger woman with unwanted pregnancies.The safety of
psychotropic medication cannot be clearly established because robust,
prospective trials are obviously unethical.If drug treatment in pregnancy
is considered,older medications such as chlorpromazine,trifluoperazine are
recommended as more clinical experience has accumulated with these drugs
than the newer ,novel atypical antipsychotic medications.Inaddition older
drugs are generally considered to have minimal risk of teratogenicity.
Data on some atypicals are now emerging.Clozapine is not known to be
associated with teratogenicity but may pose extra risks in pregnancy given
the inability to monitor fetal hematology. Not all authorities agree that
olanzapine is likely to be free of teratogenicity. Gestational diabetes is
associated with both clozapine and olanzapine.

Psychiatrists should make an individualised assessment of risks and
benefits of antipychotic medications,discuss with patients risks versus
benefits, document all decisions, should not hesitate to seek advice from
manufacturers, pharmacists and other specialists.

Older antipsychotics clearly have a role in this vulnerable group.

references

1.Taylor D,Paton C,Kerwin R,The Maudsley prescribing guidelines 2005-
2006 8th edition.

2.Altshuler LL, Cohen L,Szuba MP et al,Pharmacological management of
psychiatric illness during pregnancy:dilemmas and guidelines,Am J Psych
(1996) 153:592-606.
Patton SW,Misri S,Corral MR et al.Antipsychotic medication during
pregnancy and lactation:evaluating the risk . Can J Psychiatry 2003;
47:959-965

Competing interests:
None declared

Competing interests: No competing interests

17 November 2006
Bharathi Balasundaram
specialist registrar old age psychiatry,Leeds mental health trust ,Leeds
Ls14 1PP