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Atypical antipsychotic agents: a critical review
J A Worrel1, P A Marken, S E Beckman
1Psychiatry, St. Cloud Veterans Affairs Medical Center, MN, USA.
Summary
Atypical antipsychotics offer improved efficacy and fewer side effects than typical agents for schizophrenia. While more expensive, they show promise for various psychiatric conditions, with clozapine standard for treatment-resistant cases.
Area of Science:
- Psychiatry
- Pharmacology
- Neuroscience
Background:
- Typical antipsychotics have limitations including inadequate efficacy for negative symptoms and troublesome side effects like extrapyramidal symptoms (EPSs) and tardive dyskinesia (TD).
- Atypical antipsychotics were developed to address these issues, differing in their receptor binding profiles, specifically "limbic-specific" dopamine D2-receptor binding and a high serotonin 5-HT2 to D2 receptor binding ratio.
Purpose of the Study:
- To review the pharmacology, efficacy, and adverse effects of atypical antipsychotic agents.
- To compare the effectiveness of atypical antipsychotics against placebo and typical agents in treating schizophrenia.
- To discuss the broader applications and cost-effectiveness of atypical antipsychotics.
Main Methods:
- Review of pharmacological properties and clinical trial data for atypical antipsychotics.
- Comparison of efficacy and adverse event profiles of atypical agents versus placebo and typical antipsychotics (e.g., haloperidol).
- Analysis of data for treatment-resistant schizophrenia and other psychiatric indications.
Main Results:
- Risperidone and olanzapine demonstrated superiority over placebo for positive and negative symptoms in non-treatment-resistant schizophrenia, with some advantages over haloperidol.
- Quetiapine showed improvement over placebo but was not superior to typical antipsychotics.
- Clozapine remains the standard for treatment-resistant schizophrenia. Head-to-head comparisons of atypical agents have been inconclusive.
- Atypical antipsychotics are associated with a lower incidence of EPSs, TD, neuroleptic malignant syndrome, and hyperprolactinemia compared to typical agents.
- Clozapine requires monitoring for agranulocytosis.
Conclusions:
- Atypical antipsychotics are effective first-line treatments for schizophrenia, offering improved tolerability and efficacy, particularly for negative symptoms.
- Despite higher costs, their overall efficiency may be enhanced by considering quality of life improvements.
- These agents are increasingly utilized for other conditions like aggression, mania, and depression, showing promise in psychiatric and neurologic care.