Many parents complained that after their children took medication for schizophrenia, their original hallucinations and delusions, etc., were significantly improved, but some new problems emerged, such as: complaining that they could not easily concentrate their thoughts, their brains could not turn, they could not remember things, and they even felt their brains were blank; appearing childish, clinging to their parents, following them around all day long, and even wanting to touch their parents’ hidden places or kiss their faces; easily lose temper, drop things, regret afterwards, and apologize; ……. Many doctors simply classify these conditions as ‘negative symptoms’ and advocate increasing the dose of antipsychotics. In fact, these conditions are certainly not negative symptoms; they are all just signs of poor self-control. There is a developmental process of self-control in people. Small children, they can not control their behavior, can not restrain their impulsive desires, because their self-control ability has not yet developed. Generally speaking, by the age of 7, self-control can be developed to the level of 70% to 80% of adults, as evidenced by the ability to restrain themselves and sit quietly in class for more than 20 minutes. This is why the state requires that children can go to school at the age of 7. However, some children who develop poorly or late may be hyperactive, have difficulty concentrating, often wander off, and tend to be impulsive and capricious, which is generally referred to as ‘ADHD’. In fact, this is not a ‘disease’, but only the development of personality problems. It is generally said that self-control can get better with age. However, there are some children who can no longer be taught quietly in the classroom like other children and develop all kinds of problems, and then they need therapeutic intervention. Such children make up about 5 to 10% of the total population. In other words, 5 to 10% of the total population, have less self-control. Even if they are older and will develop better, they are still not as good as the other 80-90% of adults. This is what is generally referred to as a ‘personality problem’. If this causes various problems with the community or people around you, this is what is called a ‘personality disorder’. Self-control is related to the neurotransmitter “norepinephrine (NE)”, which transmits information between brain cells. Any drug that increases NE has the effect of enhancing self-control, such as Ritalin, Maprotiline, Reboxetine, and Tomoxetine. Many antipsychotics, in contrast, block NE receptors, which equates to a decrease in NE neurotransmission and therefore diminishes self-control. It is this reasoning that after the application of antipsychotics to treat schizophrenia and achieve efficacy, yet these new problems arise. I have published some information on ‘antipsychotic-receptor binding relationship’ in my article, and I will briefly mention it again here: any drug with good (small) binding ability to the a1 receptor is more likely to block the NE receptor, and it is also more likely to reduce self-control and show those manifestations above. It seems that only haloperidol, sulpiride, and pentoxifylline, which have a poor ability to bind to the a1 receptor, have less effect on NE, so there is less potential for these problems. Amisulpride is a descendant of sulpiride, for which there are no experimental data in this material, and which is presumably similar. ======================================= haloperidol 46 (sulpiride and pentoxifylline are similar) risperidone 2 ziprasidone 12 olanzapine 19 clozapine 7 quetiapine 7 ============================================ reboxetine In the case of SSRI treatment of depression, when the effect is not satisfactory, you can add Maprotiline or Reboxetine. We can also use them alone to enhance self-control, to treat ADHD, or to treat lower self-control triggered by the antipsychotics just described. The dose of Reboxetine should be adjusted on its own as needed. Start with 4 mg once a day in the morning and once at 5 or 6 pm. Then increase to 8 mg per dose, as needed. Maprotiline has some drowsiness side effects and can be taken once in the evening or split twice daily at a dose of 50 to 150 mg per day (25 mg per tablet). Maprotiline, must be properly stored, as there is a risk of poisoning and death if overdosed. The mechanism of action of Ritalin is not exactly the same, it is to drive out the neurotransmitters (whether DA, 5HT, NE, or ACh) from the nerve endings of brain cells; and it only has a duration of action of 3 to 4 h. The increase in DA is not conducive to the treatment of schizophrenia, so Ritalin should not be applied at this time. As for tomoxetine, the mechanism of action is the same as reboxetine, but it is just more expensive. In the case of hyperactive children, it is as shown in the chart. Drugs such as reboxetine can temporarily increase self-control to the level expected for that age; however, once the drug is stopped, it returns to the same level. …… until the child’s own self-control reaches a certain level with growth and development. Generally speaking, it is always a little less than others. If the reduction in self-control is caused by the use of antipsychotic medication, it will return to the original level after the medication is discontinued or the maintenance dose is changed. If antipsychotic medication is added to reboxetine, it is possible that self-control will improve until the medication is stopped or the maintenance dose is changed, and self-control will remain at the same level. However, if the child is hyperactive, it is unlikely to be the same as a normal person, and self-control is always worse than others.