[Problems of psychotropic drugs in psychopharmacotherapy].

This is the summary of the lecture that the author, as a clinical psychiatrist, gave to the Japanese researchers of basic psychopharmacology who are not involved in clinical medicine. I. The author considers the problems of psychotropic drugs in Japan in 2 categories: those unique to Japan (1-5) and those related to psychotropic drugs in general (6-9). 1. "Arbitrary" administration (i. e., the prescription is different with each psychiatrist, therefore standardization is necessary). 2. Polypharmacy (i. e., unreasonable combination is made). 3. Many different drugs with similar effect (therefore, new drugs should be controlled). 4. "Stereotype" of doctor's prescription for long-term use. 5. Limited prescription due to health insurances. 6. Doubtful effect on long-term prognosis of chronic schizophrenics. 7. Psycho-social burden of patients taking drugs continuously. 8. Undesirable effects like prolongation of depressive episode, lowered mental activity, or blunting of affect. 9. Side effects such as dependence, tardive dyskinesia, malignant syndrome, or teratogenecity. II. Tardive dyskinesea, malignant syndrome and teratogenecity are explained in detail. III. The author expresses the wishes for future development of psychotropic drugs as follows: 1. Good balance of "effect", "side effect", and "price" of clinical drugs. 2. Introduction of safe long-acting drugs which promote social rehabilitation of mental patients. 3. Development of more specifically effective drugs. 4. Convenient way of measurement of drug serum level. 5. Contribution to understanding of pathogenesis of mental disorders through researches on effects and side effects of drugs. Finally, the author stresses the necessity of more cooperation between clinical and basic medicine.