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An Evaluation of Chlorpromazine ("Largactil") in Psychiatry

Cane Hill Hospital, Coulsdon, Surrey

ABSTRACT

The results of parenteral administration of chlorpromazine in a series of 27 female in-patients have been described. The drug was administered alone, and in combination with phenobarbitone, butobarbitone, phenergan, and diparcol. Symptomatic improvement occurred in 7 out of 8 excited and impulsive, or aggressive schizophrenics, and was very marked in 4 cases. These effects were brought about by an average daily dosage of 200 mgm. The results in mania were less impressive, but 2 out of 7 patients obtained remissions after treatment with chlorpromazine. Another patient with a mixed psychosis, who had had earlier remissions after two pre-frontal leucotomies, again remitted following chlorpromazine.

The drug was inactive in 22 major psychoses when administered by mouth in doses of up to 300 mgm. per day, although the presence of side effects showed that it was being absorbed.

When combined with barbiturates, phenergan, and diparcol, chlorpromazine can be used to produce a continuous narcosis, which gives rise to considerably fewer toxic effects than in the earlier described methods of drug narcosis. In this sense, the method of "artificial hibernation" (chlorpromazine narcosis), represents a distinct advance, but is unlikely to find its major application in the treatment of the psychoses. In the present series of 11 patients, only one showed any benefit from the treatment. This experience is identical with that of Continental workers.

The main toxic effects of chlorpromazine are (a) local irritation, which can largely be prevented by adequate dilution, i.e. 50 mgm. chlorpromazine in 5 c.cm., or a 1 per cent. solution, and (b) toxic jaundice, which so far has been observed in occasional cases on varying doses of chlorpromazine. The undesired side effects of the drug, i.e. tachycardia, orthostatic fainting, etc., do not appear to be a contraindication to its use in the control of psychotic excitement.

On the basis of the present results, chlorpromazine is regarded as the drug of choice in the management of acute excitement, being in this respect probably as efficacious as electroshock. The drug is most effective in schizophrenic excitements. The rapid reduction of aggressiveness, diminution in psychomotor overactivity, without the production of drowsiness or confusion, renders the drug particularly valuable in facilitating psychotherapeutic contact. Unfortunately, tolerance quickly develops in some patients, so that the beneficial effect may disappear after 10–14 days. Despite this limitation, however, chlorpromazine represents a definite therapeutic advance in the treatment of psychotic excitement.