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episode patients and the elderly.

(2)More scientific information from controlled trials and clinical observations is urgently needed in several areas. First, more comparisons between the SGAMs are needed to establish their differential risk/benefit profiles. Also, more comparisons of SGAMs with FGAMs, particularly at low and equivalent doses, are needed.   Research is needed on the use of the SGAMs in children and adolescents with psychotic and other disorders, and on the effects of these substances on women, elderly patients and patients with other concurrent physical and mental disorders.  More information is also needed on the long-term effects of treatment (in terms of safety and effectiveness) and the effects of these medications on people belonging to different geographically, culturally and genetically defined groups. It is of particular importance to ensure that developing countries participate in studies assessing these therapeutic agents.

The pharmaceutical industry contributes significant funding for research leading to the development of new medications, and on the assessment of the effects of the medications. The need to obtain relevant data on treatments for mental illness is so great that these efforts will not be sufficient: governments must find ways to make similar investments in research on treatment and service-organization.

(3)The emerging body of information on the efficacy and safety of  the SGAMs, and their increasing use, does not mean that the FGAMs have no role in the treatment of schizophrenia and other disorders for which their use is indicated. There are clearly indicated continued uses in the management of patients with acute agitation, in floridly psychotic patients, in patients needing long-acting medication forms in which SGAMs are not widely available, and in patients who are stable and effectively tolerating treatment with FGAMs.

(4)The cost of SGAMs is often mentioned as the main reason for restricting their use. Although the costs of these medications on “per tablet”, daily and annual-ized bases are significantly higher than those of classical antipsychotic drugs, it should be remembered that the cost of medications, at least in developed countries, represents only a small proportion of the total cost of health care for these populations (particularly if the treatment is provided on an in-patient basis). Thus, while medication costs may be higher, the total cost of treatment with the SGAMs could well be lower than that of treatment using the FGAMs. Furthermore, according to an increasing number of reports, improvement of quality of life is greater when the disease is treated with the SGAMs {240]. Unfortunately, this feature often does not enter into the calculation of the benefits of treatment.  Indeed, the use of cost as the basis for restricting treatment with SGAMs is a reflection of the stigma of mental illness: the cost of other medications, e.g. immunosuppresive drugs or antibiotics, is not viewed in this manner, because societies consider the transplantation of organs and the treatment of infectious diseases very important.   

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