Atypical Antipsychotics: Treatment for Schizophrenia

Atypical antipsychotic drugs are a type of psychiatric medication, otherwise known as "second generation antipsychotics," that are commonly used to treat certain psychiatric conditions such as schizophrenia and other psychotic disorders as well as in the treatment of certain mood disorders. 

Atypical antipsychotics are a class of medication that was developed after the first generation antipsychotics, such as haloperidol (Haldol).

These second-generation antipsychotics were embraced largely because they did not cause as many of the movement problems known as extrapyramidal symptoms, such as tardive dyskinesia, that are common side effects of the first-generation antipsychotics.

Certain of the atypical antipsychotics have also been found to be more effective than first-generation antipsychotic medications in treatment-resistant patients, and may have a greater efficacy in treating negative symptoms of psychotic disorders.

Many of the atypical antipsychotics can contribute to metabolic side effects such as weight gain, increased glucose and lipids. This article will provide a brief overview some of these medications.The following is not an exhaustive list but features some of the most commonly prescribed atypical antipsychotic medications.

Clozaril

Clozaril (clozapine) is an atypical antipsychotic that is typically used only after other medications have failed.

While it can be helpful for symptoms of severe cases of schizophrenia, it comes with the possibility of severe side effects. Treatment with Clozaril can cause a condition called agranulocytosis (loss of the white blood cells that fight infection), and therefore requires that patients be monitored with weekly blood tests.

The frequency of these tests can be reduced to every other week and ultimately monthly with continued stability. 

Zyprexa

Zyprexa (olanzapine) has many similarities to Clozaril: it appears to be similar in effectiveness and reversal of negative symptoms of psychotic disorders (e.g. apathy and withdrawal), but free of the risk of agranulocytosis. It is also used to control positive symptoms of psychotic disorders such as hallucinations and delusions. It was the first medication to be approved for the acute treatment of mania associated with bipolar illness

Risperdal

Risperdal (risperidone) is typically used for schizophrenia, irritability associated with kids from five to sixteen years old with autism spectrum disorders, and for bipolar manic or mixed episodes, sometimes in combination with a mood stabilizer.

Invega

Derived from the active metabolite of risperidone, Invega (paliperidone) is also used for the treatment of schizophrenia.  Invega and Risperdal both have long-acting injectable form that can be administered every few weeks.

 

Seroquel

Similar to Risperdal or Zyprexa, Seroquel (quetiapine) is used to treat psychotic symptoms associated with schizophrenia, which includes hallucinations, paranoia, and delusions. Seroquel is also approved to treat acute mania and is also known to have some antidepressant effects.

Abilify

Abilify (aripiprazole) is an atypical antipsychotic approved by the Food and Drug Administration (FDA) to treat symptoms of schizophrenia and bipolar disorder, including delusions, hallucinations, and paranoia. Though it is not an anti-depressant, it is also used as an adjunct treatment for adults with major depressive disorder.

Geodon 

Geodon (ziprasidone) stands apart from the other atypical antipsychotics because it is not as commonly associated with weight gain as a side effect. It is used to treat symptoms of schizophrenia, mixed and manic episodes of bipolar disorder I, and as a maintenance treatment of bipolar disorder when used in conjunction with a mood stabilizer.

Saphris

Saphris (asenapine) is used to treat acute symptoms of schizophrenia and mixed and manic symptoms of bipolar disorder. Similar to Geodon, it is associated with a lower weight gain than many of the other atypical antipsychotics.

The above list features a some of the most commonly prescribed atypical antipsychotic medications.

Sources

United States Food and Drug Administration

Leucht, S., Pitschel-Walz, G., Abraham, D., & Kissling, W. (1999) Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials, Schizophrenia Research, 35(1), 51-68.

Taylor, D.M., & McAskill, R. (2000) Atypical antipsychotics and weight gain — a systematic review, Acta Psychiatrica Scandinavica, 101(6), 416-432.

Edited by Jenev Caddell, Psy.D.

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