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A comparative review of new antipsychotics
1Centre de Pharmacologie Clinique et d'Evaluations Thérapeutiques, Hôpital de la Timone, Marseille, France. oblin@ap-hm.fr
Summary
This review compares established and new antipsychotic drugs, including clozapine and olanzapine, using a novel algorithm. Further research is needed to confirm their long-term efficacy in treating schizophrenia.
Area of Science:
- Pharmacology and Psychiatry
- Neuroscience
Background:
- Antipsychotic medications are crucial for managing psychotic disorders.
- Existing classifications rely on chemical structure, clinical effects, receptor affinity, or side effects.
- Newer agents show promise for fewer extrapyramidal side effects compared to older drugs.
Purpose of the Study:
- To review preclinical and clinical properties of established and putative antipsychotic medications.
- To propose a decision algorithm for comparing antipsychotic drugs.
- To evaluate efficacy across positive, negative, anxious, depressive, and cognitive symptoms.
Main Methods:
- Review of preclinical and clinical data for clozapine, risperidone, amisulpride, olanzapine, quetiapine, sertindole, and ziprasidone.
- Development of a decision algorithm based on biochemical profile, experimental pharmacology, and PET scan results.
- Assessment of clinical efficacy on a wide range of psychotic disorder symptoms.
Main Results:
- Preclinical data suggest potential efficacy with reduced extrapyramidal side effects.
- Current classifications are diverse, lacking a unified comparative framework.
- The biological basis for the superiority of newer antipsychotics remains to be fully elucidated.
Conclusions:
- Most antipsychotics demonstrate equivalence to haloperidol for positive symptoms.
- Further studies are essential to confirm absolute and relative efficacy on diverse symptom domains and quality of life.
- The long-term management benefits of these antipsychotics in schizophrenia require additional confirmation.