At present we are using drugs in large numbers of patients. This does not necessarily mean that these patients should not have a physical and mental examination and that details of their psychiatric illness are not appraised. Mass use of the drugs should not assume that the patient is physically well, suffering from some form of emotional disorder, and then prescribing one or the other of the tranquilizing drugs to relieve the emotional state. When we discuss some of the abuses which occur in using the drugs we will again emphasize that it is important to establish a psychiatric appraisal of the situation and know for what the drug is to be used.

The tranquilizing drugs are most effective in psychotic patients and especially in early catatonic and paranoid schizophrenic patients. Hebephrenic and simple types of schizophrenia show alteration in behavior, but they do not achieve the same amount of reintegration with the drugs observed in the other two groups. This is not new and agrees with observations learned from shock therapy and lobotomy. Again we make the observation that catatonic and paranoid forms of schizophrenia are more apt to reintegrate than the other forms of schizophrenia which have a far more disorganizing effect on psychic functioning.

In manic depressive patients the tranquilizing drugs are very effective in the manic state. They are not effective in the depressive states except in patients who suffer from agitated or tense depressions. Simple depressions, retarded depressions, and so-called neurotic depressions usually do not respond well to the drugs, and usually respond well only if features of tension or agitation are mixed in the clinical symptomatology. Actually one of the commonest mistakes today is to give a depressed patient these drugs, leave the patient unattended, and assume that the drug will control the patient’s symptomatology. The number of suicidal attempts under tranquilizing drugs is rising. Depressed patients, unless carefully supervised, should not receive tranquilizing drugs in an ambulatory setting. We should be aware of the fact that depressed patients are capable of committing suicide even when they are under the influence of the drug.

The tranquilizing drugs are very effective not alone in cutting tension and excitement, but also in influencing states of confusion or states of delirium. They are valuable adjuncts in trying to clear confusional states in the organic psychoses. For instance, in alcoholic patients who suffer from confusion, in some arteriosclerotic patients, or in patients suffering from head injuries, the drugs are most effective in calming the patient and in shortening these confusional episodes. The drugs have no effect, however, on the symptomatology of organic psychoses which fall in the realm of dementia or deterioration. In other words, patients with an enfeebled intellect respond only insofar as their behavior is better controlled and in that they are not excited or upset. A dementing process is not prevented or influenced by the drugs.

The efficacy of the tranquilizing drugs in certain psychoses is well established. The questions which are not settled are, how permanent is the improvement of these patients, how long should treatment continue, and, statistically, how many patients respond. These questions are still open and some time will elapse before we will have reliable answers to them. There is nearly complete agreement among those who use the tranquilizing drugs in state hospital settings that these drugs control excitement and disturbed behavior far better than previously used treatment. The use of restraint has dropped very markedly with the use of the drugs. Many of the patients under the influence of tranquilizing drugs not only behave better, but are able to engage in activities, are able to follow a therapeutic regime and indulge in active participation. Therefore, the idea expressed by some that these patients are only sedated and because of the sedation do not display any initiative, is not correct for the majority of patients. This is especially true for those patients who are maintained on comparatively small amounts of the drugs which do not interfere with their mental functioning and do not slow down their actions.

Related posts:

1. Drug Therapy in Psychiatry. Part 6 We feel the following trends in the use of the tranquilizing drugs should be checked. First, patients should not receive a tranquilizing drug without proper physical and mental examination. We know that some of the drugs can lead to physical complications and therefore...
2. Drug Therapy in Psychiatry. Part 2 Most of the reliable information on the action of these compounds relates to psychotic patients. A considerable literature also exists on then-use in neurotic patients. However, the interpretation of data with these patients is far less reliable than with psychotic patients. The oral...
3. Drug Therapy in Psychiatry. Part 1 October 17, 1956 We should like to discuss several aspects of the problem from a clinical point of view, namely, what kind of drugs should be selected for treatment, indications for the use of tranquilizing drugs, the question of dosages, and how long...
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