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Antipsychotic Drugs: Typical and Atypical Agents01:21

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Antipsychotic drugs are classified into first-generation (typical) drugs including phenothiazines; and second-generation (atypical) drugs. Chlorpromazine hydrochloride (Thorazine), a phenothiazine derivative, broadly impacts the central, autonomic, and endocrine systems. This drug, along with typical agents like haloperidol (Haldol), primarily works by antagonizing D2 receptors, thus reducing dopaminergic neurotransmission. However, typical antipsychotics can cause side effects such as sedation...
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Antipsychotic drugs primarily block dopamine and serotonin receptors and cholinergic, adrenergic, and histaminergic receptors, thereby reducing hallucinations and delusions in conditions like schizophrenia. However, they can trigger unwanted extrapyramidal effects such as dystonias, Parkinson-like symptoms, and tardive dyskinesia.
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The term "psychosis" refers to a spectrum of mental disorders characterized by abnormal thoughts, perceptions, and behaviors. It can manifest as mood disorders, dementia, delirium with psychotic features, substance-induced psychosis with psychotic features, brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophrenia. Among all these disorders, schizophrenia is the most common psychotic disorder, affecting 1% of the worldwide population. Psychotic...
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The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
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Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
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Related Experiment Video

Updated: Jun 1, 2025

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Lurasidone versus typical antipsychotics for schizophrenia.

Dawid Storman1, Magdalena Koperny2, Krzysztof Styczeñ3

  • 1Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland.

The Cochrane Database of Systematic Reviews
|January 20, 2025
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Summary

This review found very uncertain evidence on lurasidone versus typical antipsychotics for schizophrenia. More large-scale studies are needed to clarify the benefits and harms of lurasidone in treating schizophrenia.

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Area of Science:

  • Psychiatry
  • Clinical Pharmacology

Background:

  • Antipsychotic medications are fundamental for schizophrenia treatment.
  • While newer second-generation antipsychotics like lurasidone are available, older typical antipsychotics remain widely used globally.
  • There is limited understanding of the comparative risk-benefit profiles between newer and older antipsychotic agents.

Purpose of the Study:

  • To systematically evaluate the efficacy and safety of lurasidone compared to typical antipsychotics in adults diagnosed with schizophrenia or related disorders.

Main Methods:

  • Conducted a systematic review of randomized controlled trials (RCTs) comparing lurasidone with typical antipsychotics.
  • Searched multiple databases (Cochrane Schizophrenia Group's Study-Based Register, CENTRAL, MEDLINE, Embase) and trial registers up to April 2024.
  • Assessed risk of bias and certainty of evidence using GRADE for key outcomes including mental state, mortality, quality of life, and adverse events.

Main Results:

  • Included two RCTs with 308 participants; 223 received lurasidone and 82 received typical antipsychotics (haloperidol or perphenazine).
  • Evidence regarding lurasidone's effect on mental state (BPRS, PANSS) is very uncertain (very low-certainty evidence).
  • Evidence on total serious adverse events and severe adverse events is also very uncertain (very low-certainty evidence).

Conclusions:

  • There is significant uncertainty regarding the benefits of lurasidone for mental state, serious adverse events, or severe adverse events compared to typical antipsychotics in schizophrenia.
  • The current evidence is of very low certainty, stemming from two small trials with limitations.
  • Further large-scale randomized controlled trials are essential to elucidate the comparative benefits and harms of lurasidone versus typical antipsychotics for schizophrenia treatment.