Antipsychotic agent: Difference between revisions

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===Extrapyramidal effects===
===Extrapyramidal effects===
The second generation agents may cause less extrapyramidal effects<ref name="pmid19058842">{{cite journal |author=Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM |title=Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis |journal=Lancet |volume=373 |issue=9657 |pages=31–41 |year=2009 |month=January |pmid=19058842 |doi=10.1016/S0140-6736(08)61764-X |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)61764-X |issn=}}</ref> and [[quetiapine]] may cause the least effects among this group.<ref name="pmid17035647">{{cite journal |author=Schneider LS, Tariot PN, Dagerman KS, ''et al'' |title=Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease |journal=N. Engl. J. Med. |volume=355 |issue=15 |pages=1525–38 |year=2006 |month=October |pmid=17035647 |doi=10.1056/NEJMoa061240 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17035647&promo=ONFLNS19 |issn=}}</ref> Haloperidol less than 3 mg day reduced adverse effects.<ref name="pmid17443602">{{cite journal |author=Lonergan E, Britton AM, Luxenberg J, Wyller T |title=Antipsychotics for delirium |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD005594 |year=2007 |pmid=17443602 |doi=10.1002/14651858.CD005594.pub2 |url=http://dx.doi.org/10.1002/14651858.CD005594.pub2 |issn=}}</ref>
The second generation agents may cause less extrapyramidal effects<ref name="pmid19058842">{{cite journal |author=Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM |title=Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis |journal=Lancet |volume=373 |issue=9657 |pages=31–41 |year=2009 |month=January |pmid=19058842 |doi=10.1016/S0140-6736(08)61764-X |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)61764-X |issn=}}</ref> and [[quetiapine]] may cause the least effects among this group.<ref name="pmid17035647">{{cite journal |author=Schneider LS, Tariot PN, Dagerman KS, ''et al'' |title=Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease |journal=N. Engl. J. Med. |volume=355 |issue=15 |pages=1525–38 |year=2006 |month=October |pmid=17035647 |doi=10.1056/NEJMoa061240 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17035647&promo=ONFLNS19 |issn=}}</ref> Haloperidol less than 3 mg day reduced adverse effects.<ref name="pmid17443602">{{cite journal |author=Lonergan E, Britton AM, Luxenberg J, Wyller T |title=Antipsychotics for delirium |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD005594 |year=2007 |pmid=17443602 |doi=10.1002/14651858.CD005594.pub2 |url=http://dx.doi.org/10.1002/14651858.CD005594.pub2 |issn=}}</ref>
===Mortality===
Short term increases in mortality may occur with [[haloperidol]], [[olanzapine]], and [[risperidone]], but not [[quetiapine]].<ref name="pmid20487081">{{cite journal| author=Rossom RC, Rector TS, Lederle FA, Dysken MW| title=Are All Commonly Prescribed Antipsychotics Associated with Greater Mortality in Elderly Male Veterans with Dementia? | journal=J Am Geriatr Soc | year= 2010 | volume=  | issue=  | pages=  | pmid=20487081
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20487081 | doi=10.1111/j.1532-5415.2010.02873.x }} </ref>


===Cardiovascular effects===
===Cardiovascular effects===

Revision as of 22:20, 14 July 2010

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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

The second generation anti-psychotic agents amisulpride, clozapine, olanzapine, and risperidone may be the most effect agents for schizophrenia.[4]

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.[5] Regardless, antipsychotic agents may increase mortality.[6]

Regarding the treatment of delirium, all drugs may have similar efficacy.[7]

Risperidone help in children with autism who have serious behavioral problems a randomized controlled trial.[8]

Adverse effects

Extrapyramidal effects

The second generation agents may cause less extrapyramidal effects[4] and quetiapine may cause the least effects among this group.[2] Haloperidol less than 3 mg day reduced adverse effects.[7]

Mortality

Short term increases in mortality may occur with haloperidol, olanzapine, and risperidone, but not quetiapine.[9]

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."[10] 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"."[11]

Prolongation of the QT interval may be the most with thioridazine and least with risperidone.[12]

Metabolic effects

The second generation agents may cause hyperglycemia and hyperlipidemia; patients should be tested for these prior to treatment.[13]

Other effects

Withdrawing psychotropics agents may prevent accidental falls.[14]

References

  1. ↑ Anonymous (2024), 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. Cite error: Invalid <ref> tag; name "pmid17035647" defined multiple times with different content Cite error: Invalid <ref> tag; name "pmid17035647" defined multiple times with different content
  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. ↑ 4.0 4.1 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.
  5. ↑ 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
  6. ↑ 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
  7. ↑ 7.0 7.1 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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]
  12. ↑ Stöllberger C, Huber JO, Finsterer J (September 2005). "Antipsychotic drugs and QT prolongation". Int Clin Psychopharmacol 20 (5): 243–51. PMID 16096514. [e]
  13. ↑ 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.
  14. ↑ 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]
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