[Atypical neuroleptics--the future of schizophrenia treatment?]

Since schizophrenia is not a rare occurrence and is often chronic, the general practitioner and internist providing primary care should also be informed on new developments in treatment with neuroleptics. A major new form of treatment is provided by the so-called atypical neuroleptics which, however, in terms of their receptor specificity are not a uniform group, and have only a few properties in common. A prototype of this group is clozapine (Leponex), which has a good antipsychotic effect and virtually no action on the extrapyramidal motor system (EPS). Whether clozapine is also capable of improving the primary negative symptoms of schizophrenia (e.g. flattering of affect, reduction of drive, cognitive disorders, etc.) has not yet been ascertained. On account of the rare but possibly fatal agranulocytosis it may induce, it may be prescribed only when certain safety precautions are taken. Risperidone (Risperdal) has similar efficacy against the classical positive symptoms, with no action on the EPS (up to a medium dosage), and has no hematological effects. Other atypical neuroleptics have recently become available: quetiapine, olanzapine and sertindole. They have at least some of the advantages of clozapine but a very low risk of producing hematological effects. However, before they are widely used in the doctor's practice, further clinical experience is needed.