Abstract

Atypical antipsychotics have, according to some, revolutionised the treatment of schizophrenia. These drugs are claimed to be better tolerated than older typical drugs largely because of their lower propensity to cause acute extrapyramidal side-effects (EPSE). Some atypicals cause little or no hyperprolactinaemia. Some are suggested to cause less tardive dyskinesia than typical drugs. Many are claimed to improve, to a relatively greater extent, negative and cognitive symptoms of schizophrenia. In addition, one atypical, clozapine, is unarguably more effective than typical drugs in the treatment of refractory schizophrenia. Atypical drugs are now sometimes recommended as first choice treatment for schizophrenia (Lieberman, 1996; Tayloret al, 2000).

Highlights

  • Atypical antipsychotics have, according to some, revolutionised the treatment of schizophrenia

  • In a Japanese cohort receiving the equivalent of 64 mg/day haloperidol, 34.8% of patients showed signs of tardive dyskinesia and 40.5% had parkinsonism (Binder et al, 1987)

  • Similar findings were reported for a sample of patients in Scotland (McCreadie et al, 1992): 29% had tardive dyskinesia, 27% parkinsonism and 23% akathisia

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Summary

DAVID TAYLOR

Atypical antipsychotics have, according to some, revolutionised the treatment of schizophrenia These drugs are claimed to be better tolerated than older typical drugs largely because of their lower propensity to cause acute extrapyramidal side-effects (EPSE). This group apparently suggests that typical drugs should be first choice agents (Donnelly, 1999) on the basis that atypical drugs have only been compared with moderate or high doses of typical drugs and not with lower doses, which might be relatively better tolerated (Bebbington, 1999). How toxic are atypicals when used in cliniciandetermined doses?

Clinical dosing and adverse effect burden
Clinical trials
Plasma level studies
Receptor binding studies
Tardive dyskinesia
Findings
Conclusions

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