Is amisulpride an 'atypical' atypical antipsychotic agent?

Amisulpride is a novel antipsychotic with a pharmacological and clinical profile that differs from that of other atypical agents. Amisulpride is highly selective for dopamine D2/D3 receptor subtypes located in the limbic region, which is highly predictive of potent antipsychotic activity with a low potential to cause extrapyramidal symptoms (EPS). At the same time, its selective activity at presynaptic D2/D3 receptors is responsible for enhancing dopamine transmission, which predicts efficacy in the treatment of the negative symptoms of schizophrenia. Amisulpride thus has a unique profile: efficacy in controlling the symptoms of schizophrenia, whether predominantly positive or negative, combined with a low incidence of EPS. This profile is seen during both acute and chronic treatment. Amisulpride is therefore indeed an 'atypical atypical'--a flexible antipsychotic the use of which can be tailored to the changing needs of the patient. It is thus a suitable first-line choice for the treatment of schizophrenia.