Don’t forget antipsychoticsBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1061 (Published 23 February 2010) Cite this as: BMJ 2010;340:c1061
All rapid responses
The authors of the Practice Article on Long QT syndrome did not
include anti- psychotics in their table of drugs prolonging the QT
interval(1). They did make a reference to www. azert. org for an
apparently 'comprehensive list' (2,3).
This web- site belongs to Arizona Cert; it gives an American
viewpoint, and lists drugs according to Risk, Possible Risk and
Conditional Risk. These categories do not coincide with those in the
Maudsley Guidelines (4), which have no effect, low effect, moderate effect
and high effect. For example, sertindole is only a possible risk at
www.azert.org, but is high effect in the Maudsley Guidelines.
Also, www.azert. org cites droperidol (in the risk category), and
this drug 'is actually no longer available in the UK (because of an
association with QTc prolongation).'(5)
Droperidol is an example of a drug to which psychiatrists were
particularly overattached. It 'had been a mainstay of rapid
tranquilization in the West of Scotland', and presumably elsewhere (6),
and was actually recommended in the 2001 Maudsley Guidelines. In the
current 10th edition, it is no longer mentioned (7). It was withdrawn in
Britain on 31 March, 2001, by its own manufacturers. A FDA black box
warning was imposed on Droperidol in the same year (8).
But psychiatrists in the West of Scotland, surveyed after the demise
of droperidol, were on the whole angry that this instrument had been
removed from them.
Patients may not have been so happy with Droperidol. I, as a mere
amateur advocate, represented one patient to the now defunct Healthcare
Commission who was subjected to repeated doses of Droperidol in 1997 and
1999. Droperidol was the first anti- psychotic given in a mental hospital
to this patient (who had been receiving pimozide, also associated with QTc
prolongation, in the community beforehand). Droperidol had a vicious
impact on this patient, who felt it was about torture and punishment, not
cure and compassion.
What is often missing is the patient perspective in psychiatry, which
has no proper dialectic between patients on the one hand, and consultants
and staff on the other hand. There is the ambience of the Inquisition.
Perhaps the cruel side effects of anti- psychotics tend to be forgotten by
the psychiatric establishment. Psychiatry is a drug dictatorship where
patients can feel like impotent slaves. The regrettable history of
Droperidol indicates that anti -psychotic drugs may not be infallible
(1)Don't forget anti- psychotics. Denger D. BMJ 2010;340:c1061.
(2)Long QT syndrome. Abrams D, Perkin M, Skinner J. BMJ
(3)Anti- epileptic drug masking or perhaps 'treating' long QT
syndrome?: the dual role of phenytoin. Ivan Iniesta. Rapid Response. 8
(4)Maudsley Guidelines, 10th Edition. Pg. 102.
(5) Maudsley Guidelines, 9th Edition. Pg. 20.
(6)Droperidol dropped; consultants not consulted.Reid G and Hughson
M. Psychiatric Bulletin (2003), 27, 301-304.
(7)Maudsley Guidelines, 10th Edition.
Competing interests: No competing interests