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In the C# language, spaces, tabs, and newlines are considered to be whitespace (so named because you see only the white of the underlying page ). Extra whitespace is generally ignored in C# statements. Thus, you can write:

Hospitalization is often necessary, particularly when the patient s behavior shows gross disorganization The presence

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of competent family members lessens the need for hospitalization, and each case should be judged individually The major considerations are to prevent self-inflicted harm or harm to others and to provide the patient s basic needs A full medical evaluation and CT scan or MRI should be considered in first episodes of schizophreniform disorder and other psychotic episodes of unknown cause Antipsychotic medications (see below) are the treatment of choice They block the response to stimulation The relapse rate can be reduced by 50% with proper maintenance neuroleptic therapy Long-acting, injectable depot neuroleptics are used in noncompliant patients or nonresponders to oral medication Antipsychotic drugs include the typical neuroleptics phenothiazines, thioxanthenes (both similar in structure), butyrophenones, dihydroindolones, dibenzoxazepines, and benzisoxazoles, and the newer atypical neuroleptics clozapine, risperidone, olanzapine, quetiapine, aripiprazole, and ziprasidone (Table 25 4) Generally, increasing milligram potency of the typical neuroleptics is associated with decreasing anticholinergic and adrenergic side effects and increasing extrapyramidal symptoms (Table 25 5) For example, chlorpromazine has lower potency and more severe anticholinergic and adrenergic side effects The increased anticholinergic effect of chlorpromazine, however, lowers the risk of extrapyramidal symptoms The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study was a complex investigation that compared atypical and typical neuroleptic drugs Although it was not definitive, it suggested similar antipsychotic efficacy for both classes and a tendency for the atypicals, particularly olanzapine, to be better tolerated leading to enhanced compliance It also highlighted lack of patient adherence as a major factor in treatments The phenothiazines comprise the bulk of the currently used typical neuroleptic drugs The only butyrophenone commonly used in psychiatry is haloperidol, which is totally different in structure but very similar in action and side effects to the piperazine phenothiazines such as fluphenazine, perphenazine, and trifluoperazine These drugs and haloperidol (dopamine [D2] receptor blockers) have high potency and a paucity of autonomic side effects and act to markedly lower arousal levels Molindone and loxapine, while less potent, are similar in action, side effects, and safety to the piperazine phenothiazines The first atypical (novel) antipsychotic drug developed, clozapine, a dibenzodiazepine derivative, has dopamine (D4) receptor-blocking activity as well as central serotonergic, histaminergic, and -noradrenergic receptorblocking activity It is effective in the treatment of about 30% of psychoses resistant to other neuroleptic drugs Research suggests that clozapine may have specific efficacy in decreasing suicidality in patients with schizophrenia It is associated with a 1% risk of agranulocytosis, which requires weekly white blood cell count monitoring for the first 6 months followed by monitoring every other week Weekly monitoring for 1 month after discontinuation of the medication is recommended Because of an association between clozapine and myocarditis, the drug is contraindicated in patients with severe heart disease.

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Usual Daily Oral Dose 100 400 mg 100 400 mg 50 200 mg 16 32 mg 5 15 mg 2 10 mg 5 10 mg 30 100 mg 20 60 mg 300 450 mg 2 5 mg 2 6 mg 5 10 mg 200 400 mg 40 160 mg 10 15 mg Usual Daily Maximum Dose1 1g 600 mg 400 mg 64 mg 60 mg 60 mg 80 mg 225 mg 200 mg 900 mg 60 mg 10 mg 10 mg 800 mg 160 mg 30 mg $154/16 mg $158/10 mg $115/10 mg $065/10 mg $403/50 mg $257/50 mg $342/100 mg $252/20 mg $710/2 mg $1235/10 mg $702/200 mg $572/80 mg $1852/30 mg Cost for 30 Days Treatment Based on Maximum Dosage2 $15750 $12060 Not available in USA $18480 $28440 $20700 $15600 $54405 $30840 $92340 $22680 $88508 $37050 $64860 $34302 $55560

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Drug Phenothiazines Chlorpromazine (Thorazine; others) Thioridazine (Mellaril) Mesoridazine (Serentil) Perphenazine (Trilafon)3 Trifluoperazine (Stelazine) Fluphenazine (Permitil, Prolixin)3 Thioxanthenes Thiothixene (Navane)3 Dihydroindolone Molindone (Moban) Dibenzoxazepine Loxapine (Loxitane) Dibenzodiazepine Clozapine (Clozaril) Butyrophenone Haloperidol (Haldol) Benzisoxazole Risperidone4 (Risperdal) Thienobenzodiazepine Olanzapine (Zyprexa) Dibenzothiazepine Quetiapine (Seroquel) Benzisothiazolyl piperazine Ziprasidone (Geodon) Dipiperazine Aripiprazole (Abilify)

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