Antipsychotic agent

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In medicine, antipsychotic agents "control agitated psychotic behavior, alleviate acute psychotic states, reduce psychotic symptoms, and exert a quieting effect. They are used in schizophrenia, senile dementia, transient psychosis following surgery or myocardial infarction, etc. These drugs are often referred to as neuroleptics alluding to the tendency to produce neurological side effects, but not all antipsychotics are likely to produce such effects. Many of these drugs may also be effective against nausea, emesis, and pruritus."[1]

Antipsychotics effect may be by blocking dopamine receptors (D2).

Classification

The newer drugs are called either second generation or atypical antipsychotic agents. This group includes olanzapine (Zyprexa®), quetiapine (Seroquel®), risperidone (Risperdal®), aripiprazole (Abilify®), ziprasidone, clozapine, and amisulpride.[2] The atypical antipsychotics tend to also block serotonin receptors (5HT).[3]

The older drugs are called either first generation or typical antipsychotic agents. This group includes phenothiazine derivitives such as chlorpromazine, thiozanthene derivitives such as thiothixene, and butyrophenone derivitives such as haloperidol.[3]

Effectiveness

Anti-psychotic agents are less effective uses that have not been approved by the Food and Drug Administration.[4]

Delirium

Regarding the treatment of delirium, all drugs may have similar efficacy.[5]

Mania

Antipsychotic agents may be better than mood stabilizers (valproate, ziprasidone, topiramate, lamotrigine, and gabapentin) for treatment of acute mania.[6]

Schizophrenia

The second generation anti-psychotic agents amisulpride, clozapine, olanzapine, and risperidone may be the most effect agents for schizophrenia.[7]

Dementia

Regarding the treatment of dementia, a randomized controlled trial that compared the second generation anti-psychotic agents found that none improved functioning, care needs, or quality of life with statistical significance[2]; however, olanzapine and risperidone may reduce anger.[8]

Autism

Risperidone help in children with autism who have serious behavioral problems a randomized controlled trial.[9]

Adverse effects

Extrapyramidal effects

The second generation agents may cause less extrapyramidal effects[7] and quetiapine may cause the least effects among this group.[2] Haloperidol less than 3 mg day reduced adverse effects.[5]

Mortality

Short term increases in mortality may occur with haloperidol, olanzapine, and risperidone, but not quetiapine.[10] Antipsychotic agents may increase mortality in patients with dementia.[11]

Cardiovascular effects

A retrospective cohort study concluded "current users of typical and of atypical antipsychotic drugs had a similar, dose-related increased risk of sudden cardiac death."[12] Former users do not have increased risk.

A meta-analysis concluded "all antipsychotics are associated with an increased risk of stroke, and the risk might be higher in patients receiving atypical antipsychotic"."[13]

Prolongation of the QT interval may be the most with thioridazine and least with risperidone.[14]

Metabolic effects

The second generation agents may cause hyperglycemia and hyperlipidemia; patients should be tested for these prior to treatment.[15]

Other than clozapine having the most hyperlipidemia, there is conflicting research on the relative incidence of hyperlipidemia with other second generation antipsychotic agents.[16][17]

Switching to aripiprazole may reduce hyperlipidemia.[18]

Other effects

Withdrawing psychotropics agents may prevent accidental falls.[19]

References

  1. Anonymous (2015), Antipsychotic agent (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 2.2 Schneider LS, Tariot PN, Dagerman KS, et al (October 2006). "Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease". N. Engl. J. Med. 355 (15): 1525–38. DOI:10.1056/NEJMoa061240. PMID 17035647. Research Blogging.
  3. 3.0 3.1 Katzung, Bertram G. (2006). “Antipsychotic Agents & Lithium”, Basic and Clinical Pharmacology, 10th. New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-145153-6. 
  4. Maher AR, Maglione M, Bagley S, Suttorp M, Hu JH, Ewing B et al. (2011). "Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis.". JAMA 306 (12): 1359-69. DOI:10.1001/jama.2011.1360. PMID 21954480. Research Blogging.
  5. 5.0 5.1 Lonergan E, Britton AM, Luxenberg J, Wyller T (2007). "Antipsychotics for delirium". Cochrane Database Syst Rev (2): CD005594. DOI:10.1002/14651858.CD005594.pub2. PMID 17443602. Research Blogging.
  6. Cipriani A et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet 2011 Aug 17;. Template:DOI)
  7. 7.0 7.1 Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM (January 2009). "Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis". Lancet 373 (9657): 31–41. DOI:10.1016/S0140-6736(08)61764-X. PMID 19058842. Research Blogging.
  8. Sultzer DL, Davis SM, Tariot PN, Dagerman KS, Lebowitz BD, Lyketsos CG et al. (2008). "Clinical symptom responses to atypical antipsychotic medications in Alzheimer's disease: phase 1 outcomes from the CATIE-AD effectiveness trial.". Am J Psychiatry 165 (7): 844-54. DOI:10.1176/appi.ajp.2008.07111779. PMID 18519523. PMC PMC2714365. Research Blogging. Review in: Evid Based Ment Health. 2009 Feb;12(1):20
  9. McCracken JT, McGough J, Shah B, Cronin P, Hong D, Aman MG et al. (2002). "Risperidone in children with autism and serious behavioral problems.". N Engl J Med 347 (5): 314-21. DOI:10.1056/NEJMoa013171. PMID 12151468. Research Blogging.
  10. Rossom RC, Rector TS, Lederle FA, Dysken MW (2010). "Are All Commonly Prescribed Antipsychotics Associated with Greater Mortality in Elderly Male Veterans with Dementia?". J Am Geriatr Soc. DOI:10.1111/j.1532-5415.2010.02873.x. PMID 20487081. Research Blogging.
  11. Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K et al. (2009). "The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial.". Lancet Neurol 8 (2): 151-7. DOI:10.1016/S1474-4422(08)70295-3. PMID 19138567. Research Blogging. Review in: Ann Intern Med. 2009 Jun 16;150(12):JC6-8 Review in: Evid Based Med. 2009 Aug;14(4):115
  12. Ray, Wayne A.; Cecilia P. Chung, Katherine T. Murray, Kathi Hall, C. Michael Stein (2009-01-15). "Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death". N Engl J Med 360 (3): 225-235. DOI:10.1056/NEJMoa0806994. PMID 19144938. Retrieved on 2009-01-15. Research Blogging.
  13. Douglas IJ, Smeeth L (2008). "Exposure to antipsychotics and risk of stroke: self controlled case series study". BMJ 337: a1227. PMID 18755769. PMC 2526549[e]
  14. Stöllberger C, Huber JO, Finsterer J (September 2005). "Antipsychotic drugs and QT prolongation". Int Clin Psychopharmacol 20 (5): 243–51. PMID 16096514[e]
  15. Morrato EH, Druss B, Hartung DM, Valuck RJ, Allen R, Campagna E et al. (2010). "Metabolic testing rates in 3 state Medicaid programs after FDA warnings and ADA/APA recommendations for second-generation antipsychotic drugs.". Arch Gen Psychiatry 67 (1): 17-24. DOI:10.1001/archgenpsychiatry.2009.179. PMID 20048219. Research Blogging.
  16. Olfson M, Marcus SC, Corey-Lisle P, Tuomari AV, Hines P, L'Italien GJ (2006). "Hyperlipidemia following treatment with antipsychotic medications.". Am J Psychiatry 163 (10): 1821-5. DOI:10.1176/appi.ajp.163.10.1821. PMID 17012695. Research Blogging.
  17. Lambert BL, Chang KY, Tafesse E, Carson W (2005). "Association between antipsychotic treatment and hyperlipidemia among California Medicaid patients with schizophrenia.". J Clin Psychopharmacol 25 (1): 12-8. PMID 15643095[e]
  18. Stroup TS, McEvoy JP, Ring KD, Hamer RH, LaVange LM, Swartz MS et al. (2011). "A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: comparison of antipsychotics for metabolic problems (CAMP).". Am J Psychiatry 168 (9): 947-56. DOI:10.1176/appi.ajp.2011.10111609. PMID 21768610. Research Blogging.
  19. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999). "Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial". J Am Geriatr Soc 47 (7): 850–3. PMID 10404930[e]