From the Guidelines
Medications that are not typical antipsychotics include lithium, benzodiazepines, and anticonvulsants, as their antipsychotic properties are not well-established, and they are not primarily used as antipsychotics 1.
Key Points
- Typical antipsychotics, also known as first-generation antipsychotics, include medications such as haloperidol, chlorpromazine, fluphenazine, perphenazine, thioridazine, and trifluoperazine 1.
- Atypical antipsychotics, also known as second-generation antipsychotics, include medications such as clozapine, risperidone, olanzapine, quetiapine, and others 1.
- The distinction between typical and atypical antipsychotics is important because they differ in their mechanism of action and side effect profiles 1.
- Lithium, benzodiazepines, and anticonvulsants may have some reported efficacy for schizophrenia in adults, but their use in youth with schizophrenia has not been studied, and their antipsychotic activity is limited 1.
Mechanism of Action and Side Effects
- Typical antipsychotics primarily block dopamine D2 receptors and often cause significant extrapyramidal symptoms (EPS) like parkinsonism, akathisia, and tardive dyskinesia 1.
- Atypical antipsychotics generally have broader receptor activity, including serotonin receptors, and typically cause fewer EPS but may have different side effects such as metabolic issues (weight gain, diabetes risk) and sedation 1.
Clinical Considerations
- When prescribing antipsychotics, it's essential to consider the specific symptom profile of the patient and potential side effects of each medication class 1.
- Systematic studies are needed to establish the efficacy and safety of atypical antipsychotic medications in juveniles 1.
From the FDA Drug Label
Atypical antipsychotic drugs, including clozapine have been associated with metabolic changes that can increase cardiovascular and cerebrovascular risk. Atypical antipsychotic drugs have been associated with metabolic changes that include hyperglycemia/diabetes mellitus, dyslipidemia, and body weight gain.
The medications that are not typical antipsychotics are atypical antipsychotics, which include:
From the Research
Medications Not Classified as Typical Antipsychotics
The following medications are not typical antipsychotics:
- Aripiprazole
- Clozapine
- Lurasidone
- Olanzapine
- Quetiapine
- Risperidone
Characteristics of Atypical Antipsychotics
Atypical antipsychotics differ from typical antipsychotics in their pharmacology, efficacy, and adverse effects 4, 5. They have a "limbic-specific" dopamine type 2 (D2)-receptor binding and a high ratio of serotonin type 2 (5-HT2)-receptor binding to D2 binding 5.
Comparison with Typical Antipsychotics
Atypical antipsychotics are often more effective than typical antipsychotics in treating negative symptoms, cognitive impairment, and mood symptoms, as well as reducing the risk for suicide and decreasing aggression 4. They are also associated with a decreased capacity to cause extrapyramidal side effects, tardive dyskinesia, neuroleptic malignant syndrome, and hyperprolactinemia 5.
Use in Treatment-Resistant Schizophrenia
Atypical antipsychotics, such as aripiprazole, lurasidone, olanzapine, and risperidone, can be more effective than typical antipsychotics for treatment-resistant schizophrenia 4. Clozapine is uniquely indicated for reducing the risk for suicide 4.
Other Indications
Atypical antipsychotics are increasingly being used for indications other than schizophrenia, such as the management of aggression, mania, and depression 5.