Atypical Antipsychotic Use in the Treatment of Psychosis in Primary Care

Abstract

Atypical antipsychotics are a class of novel agents increasingly employed for the treatment of psychotic disorders. The pharmacodynamic properties of the atypicals appear to impact a broader spectrum of psychotic symptoms than had been appreciated with older generation antipsychotics. In addition, the atypical agents appear to have a reduced risk of neurologic side effects compared with conventional antipsychotic use. Both of these features enhance the appeal of the atypical antipsychotics and may be associated with enhanced patient compliance. The atypical antipsychotics appear to be effective for schizophrenia as well as other psychotic disorders, including schizoaffective disorder and mood disorders with psychotic features. Consequently, atypical antipsychotics are now considered to be the first-line treatment for schizophrenia, with the exception of clozapine, which is considered a second-line agent because of risks associated with its use. This review will discuss the literature on atypical antipsychotic efficacy in psychotic disorders. Issues related to antipsychotic use, dosing, adverse effects, and drug interactions are also discussed.

Atypical Antipsychotics and a Src Kinase Inhibitor (PP1) Prevent Cortical Injury Produced by the Psychomimetic, Noncompetitive NMDA Receptor Antagonist MK-801

“…The most potent atypical antipsychotic drugs were olanzapine, risperidone, and clozapine with ziprasidone and quetiapine being an order of magnitude less potent. This potency profile is similar to that observed in the treatment of humans with psychosis (Leo and Regno, 2000;Miyamoto et al, 2005;Sprague et al, 2004). This animal data must be considered with caution since only a few atypical antipsychotics were tested, a variety of drugs block injury produced by MK-801, and both oral and i.p.…”

“…Although doses vary, the average doses of the atypicals used to treat psychosis in humans are as follows: risperidone, 4-8 mg/day; olanzapine 5-20 mg/day; clozapine 6.25-400 mg/ day; ziprasidone 40-160 mg/day; and quetiapine 130-800 mg/day (Leo and Regno, 2000;Miyamoto et al, 2005;Sprague et al, 2004). This potency profile compares roughly to the potency in the present study of olanzapine4risper-idone4clozapine4ziprasidone4quetiapine.…”

“…The actions on non-D2 receptors are thought to account for their effects on the negative symptoms of schizophrenia (Leo and Regno, 2000;Miyamoto et al, 2005;Sprague et al, 2004).…”

Predictors and markers of clozapine response

“…With the atypical agents now recommended as first-line treatment (Leo and Regno 2000;Stahl and Grady 2004), there are now a number of options other than clozapine available. However, over the course of treatment, there may well be clinical situations where clozapine represents the preferred treatment, even amongst the other atypicals.…”

Comparing the Effect of Second-Generation Antipsychotics Versus Selective Serotonin Reuptake Inhibitors in Refractory Obsessive-Compulsive Disorder: a Systematic Review of the Past, Present, and Future Clinical Trials

“…Antipsychotic drugs are, therefore, used in the acute treatment, chronic psychotic disorders, and other psychiatric conditions [4,5]. Firstgeneration antipsychotic medications (FGAs), which are also known as classical neuroleptic or traditional antipsychotics, which typically used to treat psychosis such as schizophrenia, acute mania, agitation, and other psychiatric conditions [6].…”