A 26-year-old man with schizophrenia and tardive dyskinesia. Which is the most appropriate pharmacotherapeutic agent?
Valproic acid is an anticonvulsant used as a mood stabilizer. It is found useful in the treatment of mania in a bipolar disorder. It has also been valuable in the treatment of rapid cycling bipolar patients. Paroxetine is an example of a selective serotonin reuptake inhibitor (SSRI), which is a newer form of antidepressant. The SSRis are being found to be as effective as the tricyclic antidepressants. Haloperidol is an example of a neuroleptic or antipsychotic medication useful in the management of acute psychosis, as well as long-term care. Clozapine is a newer atypical antipsychotic medication. It is not associated with tardive dyskinesia as are the older neuroleptics. This makes it a drug of choice for individuals who have developed signs of tardive dyskinesia after using other neuroleptics. Problems with agranulocytosis prevent clozapine from being used as a "first line" neuroleptic. Ref: Meltzer H.Y., Bobo W.V., Heckers S.H., Fatemi H.S. (2008). Chapter 16. Schizophrenia. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds),CURRENT Diagnosis & Treatment: Psychiatry, 2e.
Clozapine
Valproic acid
Haloperidol
Paroxetine