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Sedation, often accompanied by fatigue, can be useful early in treatment but a liability after the patient has improved. All antipsychotics can be sedating in some patients at some dosage, but chlorpromazine is generally the most sedating. Its sedative effects are often judged to be very unpleasant by non–psychiatrically ill volunteers receiving even 25 mg or 50 mg of the drug in a single dose, but these effects are sometimes accepted or even welcomed by some patients with psychosis or personality disorders. Thioridazine, chlorprothixene, and loxapine are also often relatively sedating, whereas the other high-potency antipsychotics are often less or not at all sedating. In one acute-dosing strategy, the antipsychotic dosage is gradually raised until the psychosis is controlled; at that point the patient develops increased sedation, which then requires dosage reduction. In chronic administration, sedation and fatigue overlap with akinesia, a side effect characterized by inertia, inactivity, and lack of spontaneous movement. Akinesia will often abate when an antiparkinsonian drug is added; it will often abate more slowly when the dosage is lowered. When antipsychotics are used as prn medication (orally or parenterally), it is likely that sedation is the main effect produced, even though a decrease in psychosis may be desired. As has been discussed, a benzodiazepine (e.g., lorazepam 1–2 mg) may be more appropriate for this purpose. Unfortunately, the short-term (or long-term) utility of prn medication of any sort has never been seriously studied.

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Table Reference Number
Table 4–5. Antiparkinsonian drugs: names, formulations and strengths, and dosage ranges
Table Reference Number
Table 4–6. Operational criteria for diagnosis of neuroleptic malignant syndrome

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