Atypical Antipsychotics: A Practical Review

Donna A. Wirshing, MD, William C. Wirshing, MD, Stephen R. Marder, MD, C. Scott Saunders, MD, Elizabeth H. Rossotto, PhD, Stephen M. Erhart, MD

Disclosures

Medscape Psychiatry & Mental Health eJournal. 1997;2(5) 

In This Article

Abstract & Introduction

As we enter the new millennium, newer safer treatments for schizophrenia are emerging. This article reviews the available safety, clinical efficacy, and dosing data that currently exist for the new antipsychotics--clozapine, olanzapine, quetiapine, risperidone, sertindole, and ziprasidone. Additionally, an extensive literature review was performed, which is presented as a table that reflects our current knowledge about these medications' clinical efficacy in disorders other than schizophrenia.

Half a century ago, Delay and colleagues[1] discovered that the antihistamine-like compound chlorpromazine could relieve psychotic symptoms, but with its efficacy came a predictable cost of iatrogenic parkinsonism--the first noted extrapyramidal side effect (EPS). Now, as we near the next millennium, new antipsychotic medications are being developed. These new agents are not neuroleptics--or, at least, not quite so much as the conventional medications. All of the agents mentioned in this article are effective antipsychotics with minimal or negligible EPS. This separation of clinical efficacy from neurotoxicity is what distinguishes these agents from conventional medications like haloperidol and chlorpromazine. Such an advantage alone would be sufficient to make these drugs important therapeutic breakthroughs. However, these drugs also appear to possess greater effectiveness in treating the so-called negative symptoms of schizophrenia and in remediating certain other symptom clusters (eg, violence, behavioral dyscontrol, and neurocognitive embarrassment). This apparent superiority could result from the reduction in EPS or a direct pharmacologic effect. In either case, this effect may be shown to be important in improving the social and vocational outcome of patients with psychotic disorders.

This article reviews the important safety, clinical efficacy, and dosing issues for all the new antipsychotic medications. We also summarize the current literature on the use of novel antipsychotics in disorders other than schizophrenia.

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