R.Emsley Department of Psychiatry, Cape Town, South Africa

The introduction of new technologies and medications into clinical psychiatry has resulted in a widening of the gap in the standard of care between developed and developing countries. For example, the considerable advantages of the atypical antipsychotics are likely to make a substantial difference to patients in terms of improved social and vocational functioning and general quality of life. However, the greater acquisition costs of these drugs put them beyond the reach of large sectors of the world’s population – their availability in Africa is extremely limited. To make matters worse, in developing countries policy makers usually award low priority to the development of services for people with mental illness, other health issues being perceived as more important. Research findings in the developed world cannot be generalized to developing countries. Cost-effectiveness studies in low-income countries need to be undertaken other more affordable treatments need to be researched. The considerable evidence for improved safety and efficacy of low-dose compared to high-dose calassical antipsychotics offers an alternative that could be implemented in low-income countries.

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