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  1. Richard Lehman, MRCGP, MA
  1. Department of Primary Care, Oxford UniversityOxford, UK

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    When the first Indo-European settlers in the Greek peninsula decided to use the prefix A to indicate negation, they unleashed consequences that are with us to this day. The most profound was the invention of the first alphabet to have written vowels, essential in order to distinguish a written word from its opposite. Another was to create confusion among English speaking doctors, who have to choose between saying that a patient has a symptomatic hernia or asymptomatic hernia, atypical pneumonia or a typical pneumonia.Psychiatry fares even worse, because what was once atypical has now become typical. Most psychotic patients today are typically taking atypical antipsychotics, some of which, like clozapine, have been with us for 30 years. It would be much better to call them non-phenothiazine antipsychotics. Clozapine is a dibenzodiazepine, whereas risperidone blocks 5HT2 and dopamine D2 receptors. A recent study (

    ) randomly assigned 68 patients with refractory schizophrenia to a combination of the 2 or clozapine alone, and found no difference.These “atypical” drugs, and several others, are also often …

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