From the Guidelines
Antipsychotics are a crucial class of medications for managing psychotic disorders, primarily schizophrenia, and are divided into first-generation (typical) and second-generation (atypical) antipsychotics, with the latter generally preferred due to their broader receptor profiles and lower risk of extrapyramidal side effects (EPS) 1.
Key Concepts of Antipsychotics
- Antipsychotics are primarily used to treat psychotic disorders like schizophrenia, bipolar disorder with psychotic features, and other conditions with psychosis.
- They are categorized into two main types: first-generation (typical) antipsychotics, such as haloperidol, chlorpromazine, and fluphenazine, which work mainly by blocking dopamine D2 receptors, and second-generation (atypical) antipsychotics, like risperidone, olanzapine, quetiapine, and aripiprazole, which have broader receptor profiles, affecting both dopamine and serotonin receptors.
- The choice of antipsychotic and its dosage varies significantly depending on the medication and the condition being treated, with considerations for side effects, efficacy, and patient preferences.
- Common side effects of antipsychotics include weight gain, metabolic changes, sedation, anticholinergic effects, and hyperprolactinemia, emphasizing the need for regular monitoring of metabolic parameters, movement disorders, and therapeutic response.
- Clozapine is recommended for patients with treatment-resistant schizophrenia due to its efficacy, but it requires regular blood monitoring because of the risk of agranulocytosis 1.
Treatment Recommendations
- The American Psychiatric Association recommends treating patients with schizophrenia with an antipsychotic medication and monitoring for effectiveness and side effects 1.
- For patients whose symptoms have improved with an antipsychotic medication, continuing treatment with the same medication is suggested, unless there are significant side effects or other considerations that warrant a change.
- Long-acting injectable antipsychotic medications are an option for patients who prefer them or have a history of poor adherence.
- Regular assessment and adjustment of the treatment plan are crucial to minimize morbidity, mortality, and to improve the quality of life for patients with schizophrenia.
Psychosocial Interventions
- Psychosocial interventions, including cognitive-behavioral therapy for psychosis (CBTp), psychoeducation, supported employment services, and assertive community treatment, are recommended as part of a comprehensive treatment plan for patients with schizophrenia 1.
- Family interventions and social skills training can also be beneficial for patients with ongoing family contact and those aiming to enhance social functioning, respectively.
- These interventions aim to address the psychosocial and cultural factors influencing the patient's condition, promoting a person-centered approach to care.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Key Concepts of Antipsychotics
The key concepts of antipsychotics, as described in various studies 2, 3, 4, 5, 6, can be summarized as follows:
- Classification: Antipsychotics can be classified into first-generation and second-generation antipsychotics.
- Efficacy: Second-generation antipsychotics are effective for treating psychotic disorders and have fewer motor side effects than first-generation antipsychotics 2, 3.
- Side Effects: Second-generation antipsychotics are associated with weight gain and metabolic disturbances 2, 6, while first-generation antipsychotics can cause extrapyramidal side effects such as akathisia, parkinsonism, dyskinesias, dystonia, and dysphoria 3, 4.
- Long-acting Antipsychotics: Long-acting injectable antipsychotics, including second-generation antipsychotics, can improve treatment compliance and increase the chances for favorable and long-lasting improvement 5.
- Medication-associated Side Effects: Second-generation antipsychotics have varying side effect liabilities, including EPS, weight gain, metabolic abnormalities, and sexual dysfunction 6.
Comparison of Antipsychotics
Some key differences between antipsychotics include:
- Switching Rates: Switching from a low-dose first-generation antipsychotic is more frequent than from a second-generation antipsychotic 4.
- Tolerability: Second-generation antipsychotics have better adherence and tolerability than low-dose first-generation antipsychotics in first-episode psychosis 4.
- Indications: Long-acting second-generation antipsychotics have specific indications, treatment strategies, and potential interactions 5.