Recent developments in the management of psychosis

Area of Science:

• Psychiatry and Pharmacology
• Neuroscience

Background:

• Antipsychotic medications are established treatments for psychosis, with varying efficacy across symptom types.
• A significant patient subset exhibits treatment resistance, and negative symptoms often remain refractory.
• Extrapyramidal side effects pose challenges with both short-term and long-term antipsychotic use.

Purpose of the Study:

• To review recently licensed antipsychotic drugs beyond classical agents.
• To compare these newer drugs with traditional antipsychotics regarding pharmacology, pharmacokinetics, clinical use, and side effect profiles.
• To identify suitable agents for specific patient populations, including those with refractory symptoms or side effect concerns.

Main Methods:

• Literature review focusing on registered antipsychotic drugs.
• Analysis of pharmacological, pharmacokinetic, clinical, and side effect data.
• Comparison of newer agents (clozapine, olanzapine, risperidone, sertindole, sulpiride) with classical antipsychotics.

Main Results:

• Five novel antipsychotic drugs have been approved, with others in late-stage clinical trials.
• These drugs exhibit distinct profiles in terms of receptor binding, absorption, distribution, metabolism, excretion, clinical efficacy, and adverse events.
• Clozapine, risperidone, and sulpiride demonstrate utility in managing treatment-resistant psychosis.

Conclusions:

• Newer antipsychotics offer alternatives for patients unresponsive to conventional treatments.
• Clozapine, risperidone, and sulpiride are recommended for refractory cases.
• Olanzapine and sertindole are also valuable considerations when managing extrapyramidal side effects.