Rational use of drugs in schizophrenia

The major tranquillisers (neuroleptics) have been in use for over 20 years to treat patients with schizophrenia. The main groups are the phenothiazines, the butyrophenones and the thioxanthenes, and all block dopaminergic neurone transmission. They are used to tranquillise disturbed patients with acute or acute-on-chronic episodes of schizophrenia, and as maintenance therapy for the suppression of psychotic phenomena in chronic patients. The general consensus is that they have improved the outlook for schizophrenic patients. Nevertheless, there are still many difficulties in their use. How can their prescription be approached rationally?