Novel or atypical antipsychotic medications appear to offer patients the be
nefits of conventional neuroleptics with lower risks of side effects, but t
he newer drugs cost much more than the older drugs. Many U.S. psychiatrists
have concluded that the novel antipsychotic drugs should be first-line the
rapy and represent an emerging standard of care in treating psychoses. This
view raises the question of whether doctors who prescribe the older, cheap
er drugs are engaging in malpractice or violating patients' rights. The aut
hors explore reasons why psychiatrists may continue treating some psychotic
patients with conventional neurolept-ics, despite the apparent advantages
of novel antipsychotics, They also describe possible sources of liability t
hat might arise from using conventional neuroleptics and examine how existi
ng case law might bear on these matters, Recent data on antipsychotic presc
ription practices and court decisions issued through September 2000 suggest
that proper use of the older drugs is not a deviation from the standard of
care. However, case law suggests that psychiatrists have a legal obligatio
n to tell patients about novel antipsychotic agents even if they continue t
o prescribe conventional neuroleptics.