Some Problems of the Medical Services of the Federation of Rhodesia and Nyasaland
Authors: H. S. Gear
Journal: BMJ (1960)

CHLORPROMAZINE AND ALLIED DRUGSB Jo 525 found to be effective for controlling overactive, aggressive, and disturbed behaviour in psychotic patients and to be superior to chlorpromazine for treating inert, withdrawn, and apathetic schizophrenics, in whom it had an altering effect, increasing both initiative and interest in the environment.Prochlorperazine is valuable for the management and treatment of alcoholism, as it relieves tension and anxiety, promotes natural sleep, and controls nausea and vomiting.Side-effects are uncommon when the daily dose is below 40 mg.Above this dose restlessness and insomnia may occur, and with doses between 75 and 100 mg.extrapyramidal manifestations are frequent.These consist in Parkinsonian rigidity and sometimes the "iexcitomotor" syndrome-that is, stiffness of the jaws, followed by trismus, spasmodic protrusion of the tongue, lip tremors, speech difficulties, torticollis, conjugate eye deviation, choreoathetoid movements, excessive sweating, and tachycardia.These effects are readily abolished either by drugs that inhibit the symptoms of Parkinson's disease or by redution in dosage.Perphenazine This drug is approximately five times as potent as chlorpromazine and has fewer side-effects.It does not produce drowsiness; on the contrary, some patients experience increased alertness and restlessness.Its main disadvantage is the tendency to cause extra- pyramidal manifestations, particularly when the daily dosage exceeds 32 mg.These consist in dystonic disturbances such as trismus, oculogyric crises, and tonic neck contractions, which sometimes spread to the muscles of the back and produce opisthotonos.Parkinsonian rigidity sometimes occurs.These extrapyramidal effects can be controlled or abolished either by anti-Parkinsonian drugs or by reduction of dosage.Perphenazine is effective in the treatment and management of acute schizophrenia and acute schizoaffective disorders, and for controlling excitement, anxiety, agitation, belligerence, -and aggressive behaviour in chronic schizophrenia and other forms of chronic psychosis.The drug helps to relieve anxiety, tension, and depression in psychosomatic disorders and physical illnesses or disabilities.It is also indicated in cases of nausea and vomiting-for example, when these are associated with pregnancy, follow surgical operations or radiation therapy, are due to drugs, or have a psychogenic origin.Other uses are for the relief of intractable pain and associated emotional distress, and the treatment of drug addiction, particularly the management of withdrawal symptoms. TrifluoperazineTrifluoperazine is about nine times more potent than chlorpromazine, having a more rapid onset of action and a more prolonged effect, which makes it unnecessary for administration to be more frequent than twice daily.This drug helps to control disturbed behaviour, aggressiveness, hallucinations, and paranoid delusions in acute and chronic psychoses.It is more effective than chlorpromazine for treating withdrawn, apathetic, and inert schizophrenics, in whom it usually produces increased alertness, initiative, and energy.