The history of neuroleptics is closely linked to that of psychiatry and the treatment of mental illnesses. Until the early 1960’s, most patients with psychotic symptoms were isolated and restrained with significant motor agitation. The therapeutic techniques used could include the use of electric current to induce an epileptic seizure in the patient, injection of insulin to cause hypoglycemic shock in order to calm the patient otherwise known as Sakel’s cure or still the baths of ice water. Psychosurgery consisted mainly of the lobotomy (Burchard & Moniz) to remove a fragment of the frontal lobe by introducing an ice pick through the ocular lobe. These so-called shock techniques had for the most part few results and presented many side effects both somatic and psychic for the patient.
It was not until 1951 and the discovery of the very first neuroleptic, chlorpromazine, by Henri Laborit who worked on anesthesia at the time to finally open the way to an effective pharmacological treatment of psychosis. Neuroleptic treatment is needed in the context of psychosis even if neuroleptics are not the drugs of psychosis in the sense that they treat them. In 1957, the psychophysiological definition of the neuroleptic (literally “seizing the nerve“) was proposed by two French psychiatrists, Delay and Deniker, based on four main criteria:
– creation of a state of psychomotor indifference
– decrease in states of excitation, aggression and agitation
– reduction of acute or chronic psychotic states (antipsychotic action)
– neurological and neurovegetative side effects
Currently, neuroleptics are divided into two major classes: classical or typical neuroleptics and atypical neuroleptics also called second generation. Although the main indication of these molecules is similar, their differences are based primarily on their mechanism of brain action. Indeed, typical neuroleptics influence by regulating dopaminergic brain transmission. The main effect of this pharmacological action is to reduce the delusional and hallucinatory activity of psychosis but has little or no effect on deficit symptoms such as autistic withdrawal or disorganization. The second class represented by the leader drug, clozapine, synthesized in the late 1950’s, this time influences not only on the delusional symptoms but also on the negative symptoms and promotes disinhibition. The desired effect can also be modulated by the prescribed dose (low, medium or high) as well as the duration of treatment (acute or chronic).
Atypical neuroleptics can sometimes combine several desired effects, which sometimes makes them more therapeutically effective. Similarly, some neuroleptics are in injectable form in cases of poor treatment adherence because it should be remembered that about 40 % of psychotics have poor compliance treatment that contributes to relapses and readmissions. With nearly 9 out of 10 patients treated with neuroleptics in case of diagnosis of psychosis, these drugs are now considered the first-line treatment in the hospital environment, before any psychotherapy. These medications indeed allow a stabilization of the state and the return of a critical consciousness in the patient then allowing to consider in a second time a psychological care. However, it should be noted that like any molecule, neuroleptics have side effects. These include extra-pyramidal or parkinsonian syndromes that manifest as resting tremors, often irreversible tardive dyskinesias, weight gain, vertigo and somnolence, state of emotional indifference, hypotension, disruption of heart rate and body temperature, and cognitive disturbances. These various side effects have a significant impact on patient’s quality of life, which implies poor compliance or even stopping treatment and possible relapse. The neuroleptics sometimes decried because of these numerous side effects remain however the only solution in case of acute symptomatology. In addition, psychotic patients remain resistant to any neuroleptic treatment and in whom other therapies are used such as electroconvulsive therapy (ECT) and also resonance transcranial magnetic stimulation (rTMS).
Words I’ve learned :
- Neuroleptic : neuroleptique
- Side effect : effet secondaire
- delusional : délirant
- critical consciousness : conscience critique
- disruption : perturbation
Bibliography :
Saoud, M. (2006). Chap VII. Thérapeutiques de la schizophrénie In Elsevier Masson (Eds). La schizophrénie de l’adulte: des causes aux traitements. Paris : Elsevier Masson.