Antipsychotic treatment in schizophrenia: atypical options and NICE guidance

Abstract

Following the reintroduction of clozapine, several atypical antipsychotics have become available for the treatment of schizophrenia. These drugs are at least as effective as conventional treatment. Although each has an individual pattern of affinities, new work suggests that the hallmark of atypicality is fast dissociation at the dopamine-2 receptor. Numerous novel drugs are in development, but it is not clear how these conform to this theory of therapeutic effect. Atypical antipsychotics cause less extrapyramidal side effects than conventional treatment, but other effects such as hyperprolactinaemia, weight gain, glucose dysregulation and prolonged QTc interval remain problematic for some. Current antipsychotic prescribing practice is far from ideal: the NICE guidance stresses that atypical treatments should be considered unless symptoms are well controlled and side effects are acceptable, or depot formulation is indicated. There is a welcome emphasis on drug treatment as part of an integrated package of care negotiated with patients and their carers.

Patterns of, and factors associated with, atypical and typical antipsychotic prescribing by general practitioners in the UK during the 1990s

“…Just as hospital psychiatrists may prescribe more atypical antipsychotics as they are often treating acutely ill patients, the prescribing of antipsychotics in primary care may be affected by a GP's experiences. Mortimer (2003) suggests that where antipsychotics are prescribed in primary care, there may be a preference for using the older typical antipsychotics as GPs are more likely to be familiar with these drugs. As the GPRD data are primary care-based, there may be a bias in lower rates of atypical antipsychotic prescribing in these data.…”

“…For example, despite recommendations against either practice, there is evidence that for patients with severe symptoms, psychiatrists often prescribe excessive dosages or prescribe more than one antipsychotic (Taylor et al, 2000;Mortimer, 2003;Paton et al, 2003). Further, there is evidence that in primary care, familiarity with the content of the National Service Frameworks in mental health is poor (Rogers et al, 2002).…”

“…It has been suggested by other UK studies that receipt of an atypical rather than a typical antipsychotic is linked to factors such as treatment history and risk of non-adherence (Mortimer, 2003;Hogman, 1996).…”

Developing tomorrow's antipsychotics: the need for a more personalised approach

“…The sub sequent development of more selective dopamine D 2 antagonists led to higherpotency antipsychotics, such as haloperidol and fluphenazine, that could be used in lower doses. In the 1990s, second generation antipsychotics were introduced and have now become first choice for the treatment of schizophrenia (Mortimer 2003).…”

Subjective Experience of Recovery from Schizophrenia-Related Disorders and Atypical Antipsychotics

“…While the atypical antipsychotic May not equal 100% due to rounding; no sig. differences by sociodemographic or clinical variables drugs are generally associated with a more benign adverse effect profile compared to the older neuroleptic agents, other adverse effects such as weight gain, hyperprolactinemia, glucose dysregulation and prolonged QTc interval remain problematic for some patients (Mortimer, 2003). This is an important issue for an effective recovery process to include attention to individual perception of adverse effects.…”