Mental Health Litigation Division
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Newer, “Atypical” Medications Considered First Choice for Antipsychotic Therapy - Implications for "Rogers" Proceedings It is now (2002) generally accepted within the psychiatric community that when antipsychotic medications are indicated, the newer, atypical, drugs <1> generally should be a practitioner’s first choice, particularly for persons suffering from schizophrenia.<2> “Unbuckling the ‘Chemical Straitjacket’:…” (see n. 2) provides a comprehensive review of the clinical and legal issues surrounding the administration of antipsychotic medication. It is must reading for all mental health counsel. While such a position has potential ramifications for the continued vitality of Rogers and its progeny,<3> of more practical concern for mental health counsel is its impact upon the substituted judgment determination in an individual client’s case. As always, of course, counsel should argue that his/her client, if competent, would opt for the least intrusive treatment modality available. Given that the atypical medications appear to be more efficacious, while presenting far more benign side-effect profiles, it would appear that in most instances counsel should argue that his/her client, if competent, would opt for the less intrusive atypical medication(s) in lieu of the Haldol, Thorazine, etc., proposed by petitioner.<4>
2. “Psychiatrists in the U.S. think that the newer antipsychotics should be the drugs of first choice for patients suffering from their first episode of schizophrenia and also should be used to treat all patients with established diagnoses of schizophrenia unless there is a good reason - a patient's personal preference, record of excellent response to an older drug, or need for an injectable preparation - to prescribe a conventional agent.” Douglas Mossman, “Unbuckling the ‘Chemical Straitjacket’: The Legal Significance of Recent Advances in the Pharmacological Treatment of Psychosis,” 39 San Diego L. Rev. 1033, 1077-78 (Fall 2002). 3. In Rogers, the SJC was primarily concerned with the many potentially quite serious adverse side-effects that often resulted from the administration of the older, “typical,” antipsychotic medications. The newer medications do not appear to present such troublesome side-effect profiles. 4. Counsel is, of course, obligated to object to the Rogers petition in its entirety. Where, however, resort to the fall-back atypical vs. typical argument is necessary, testimony of an independent psychiatrist as to the appropriateness of the atypicals for the particular client will be required. |
