Sir: We were disturbed by David Taylor's article in the December 2000 issue of the Psychiatric Bulletin (vol. 24, pp. 465-468). The paper comes across as a somewhat selective interpretation of current knowledge on this highly controversial and very topical issue. This paper clearly supports a particular point of view, giving selective weight to some studies and downplaying the importance of those that do not fit with the author's hypothesis. Some important recent studies on the issue have been completely omitted (e.g. Reference Kapur, Zipursky and JonesKapur et al, 2000) and the findings of the study by McEvoy et al (Reference McEvoy, Hogarthy and Steingard1991) are presented in such a way that the principal message of the paper is obscured. It is also regrettable that the author chooses not to consider the opinions of those leaders in the field with a different point of view (Reference Kulkarni, Power, McGorry and JacksonKulkarni & Power, 1999) and seems to disregard the side-effects of the second-generation antipsychotics altogether.
We believe that, at this time, there is insufficient evidence to come to the kind of conclusions that the author has come to and that the paper is more of a statement of personal opinion than of scientific fact. There has never been a real dose-finding study with haloperidol (or most of the traditional antipsychotics) and no proper evaluation of low-dose traditional antipsychotics v. second-generation antipsychotics. Until properly designed studies are done, it would probably be wise not to come to premature conclusions. The harsh reality is that, for most patients in the world, medications like haloperidol are the only option. Finding the optimal dose of the so-called typical antipsychotics is something that should be pursued with vigour. This issue is far from resolved and a more balanced evaluation of the current state of knowledge would be welcome.
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