Issues of choice in second-generation antipsychotic agents

Objectives: To identify and describe the most significant issues in optimal clinical use of the second-generation antipsychotics. Methods: A case report of an elderly female with treatment-refractory psychosis, negative symptoms, and tardive dyskinesia is used to focus the discussion of the clinical decisions. The rationale for switching, the choice of an appropriate compound, and the practical issues of transition from her present treatment are addressed. Conclusions: The case illustrates a common clinical scenario,focusing on the practical clinical issues in changing treatments. It draws attention to the need to carefully monitor the switch from traditional to second-generation antipsychotics. This is particularly important in patients with severe symptoms, so as not to confuse withdrawal effects from present medications with apparent failure of the new treatments.