Newer Antipsychotic Agents: Impact on Quality of Life and Alternative Applications

Abstract

The introduction of the first antipsychotic drugs in the 1950s revolutionized treatment of mentally ill patients. Patients could be treated in the community and not confined to psychiatric institutions. However, these conventional neuroleptic agents were not ideal. Although effective for the positive symptoms of schizophrenia, they had little effect on the negative symptoms. They also had distressing side effects including extrapyramidal symptoms, anticholinergic effects, and sedation that caused many patients to discontin ue treatment. In the late 1980s the first newer antipsychotic (clozapine) became avail able. Newer antipsychotics, which antagonize both the dopamine and serotonin recep tors, are effective for both the positive and negative symptoms of psychoses and are less likely than conventional neuroleptics to cause extrapyramidal symptoms at recom mended doses. Thus the newer antipsychotics may offer patients an improved quality of life while reducing costs. Clozapine is effective in up to 40% of treatment-refractory patients and may be useful in patients with mood disorders. Risperidone may be benefi cial in some treatment-refractory patients, but results in patients with mood disorders are mixed. Further study is required to explore fully all possible applications of the newer antipsychotic drugs. (Am Psychiatr Nurses Assoc [1998]. 4, S35-S41.)