Deciding about pharmacotherapy
The first steps in selecting specific drug for treatment of your patient are the establishment of diagnosis and identification of target symptoms.
If you are, after examining a prisoner, planning to use medication, you should be reminded of the following principles:
You should ask the patient about previous use of medication and its efficacy (if medical records are not available). If the prisoner reacted well to one drug, you should prescribe it again.
A history of severe adverse effects from a specific drug is a strong indicator that the patient would not benefit from that particular drug.
If the prisoner is older or has some general medical problems, you should choose drugs with fewer side effects, and as a rule start with lower doses, increase slowly and also stabilize on lower doses, having in mind the following principle: "starting low and going slow".
Most drugs of a single class have been demonstrated to be equally efficacious. However, drugs do differ in their adverse effects on individual patients.
A drug should be selected that minimally exacerbates any pre-existing medical problems that a particular patient may have.
It is important to establish a trusting relationship and this demands skills to ensure acceptance and subsequent compliance with treatment of prisoners.
Care should be taken of the possibility of non-compliance and drug abuse which are frequent among individuals with personality disorders, especially in prison settings.
Doctors should be aware of a possibility of manipulation. There might be pressures to provide inappropriate medications, or inadequate dosages from prisoners seeking oblivion, or staff pursuing quiet and passive prisoners.