Box

Prescribing psychotropics in brain injury

Small doses—start low, go slow

Only continue treatment if definite evidence of effect

Drug profile—choose drugs with less potential for:

• lowering seizure threshold—avoid chlorpromazine and clozapine

• anticholinergic activity—to minimize potential for increasing confusion

• extrapyramidal side-effects—especially akathisia, parkinsonism, and neuroleptic malignant

• Enzyme induction or other pharmacodynamic interaction with other drugs

syndrome

Regular medication with long-acting drugs, compared with short-acting drugs as required, is less

likely to produce:

• withdrawal syndrome

• development of addiction

• reinforcement of unwanted behaviour

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