Modern antipsychotic drugs: a critical overview |
| |
| Authors: | David M Gardner Ross J Baldessarini Paul Waraich |
| |
| Institution: | From the Department of Psychiatry and the College of Pharmacy, Dalhousie University, Halifax, NS (Gardner); Harvard Medical School, and the Psychopharmacology Program, McLean Division of Massachusetts General Hospital, Boston, Mass. (Baldessarini); and the Mental Health Evaluation and Community Consultation Unit, Department of Psychiatry, University of British Columbia, Vancouver, BC (Waraich)
|
| |
| Abstract: | CONVENTIONAL ANTIPSYCHOTIC DRUGS, used for a half century to treat a range of major psychiatric disorders, are being replaced in clinical practice by modern “atypical” antipsychotics, including aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone among others. As a class, the newer drugs have been promoted as being broadly clinically superior, but the evidence for this is problematic. In this brief critical overview, we consider the pharmacology, therapeutic effectiveness, tolerability, adverse effects and costs of individual modern agents versus older antipsychotic drugs. Because of typically minor differences between agents in clinical effectiveness and tolerability, and because of growing concerns about potential adverse long-term health consequences of some modern agents, it is reasonable to consider both older and newer drugs for clinical use, and it is important to inform patients of relative benefits, risks and costs of specific choices.Antipsychotic drugs are useful for treating a range of severe psychiatric disorders. Applications include the short-term treatment of acute psychotic, manic and psychotic-depressive disorders as well as agitated states in delirium and dementia and the long-term treatment of chronic psychotic disorders including schizophrenia, schizoaffective disorder and delusional disorders. Newer, “second-generation” antipsychotic drugs have largely replaced older phenothiazine, thioxanthene and butyrophenone neuroleptics in clinical practice (,2 The development of modern antipsychotic drugs was stimulated by a landmark 1988 study that showed clozapine to be superior in efficacy to chlorpromazine in schizophrenia patients resistant to high doses of haloperidol and to have none of the adverse neurologic effects typical of older antipsychotic agents.3 Clozapine was considered “atypical” in having a very low risk of adverse extrapyramidal symptoms. This term has since been applied broadly and uncritically to antipsychotic drugs marketed in the past decade, despite their striking chemical, pharmacologic and clinical heterogeneity.4 In this overview we consider the neuropharmacology, efficacy and adverse effects of conventional antipsychotics and specific modern antipsychotic drugs.Table 1 |
| |
| Keywords: | |
|
|
