Introduction

Antipsychotics, also known as neuroleptics, are a class of medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.

The use of antipsychotics may result in many unwanted side effects such as involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce adverse effects such as tardive dyskinesia.

Some antipsychotics are also licensed to treat other health problems, including: physical problems, such as persistent hiccups, problems with balance and nausea (feeling sick), agitation and psychotic experiences in dementia. This is only recommended if you pose a risk to yourself or others, or if you are severely distressed.

How do they work?

Antipsychotic drugs don't cure psychosis but they can help to reduce and control many psychotic symptoms, including: delusions and hallucinations, such as paranoia and hearing voices, anxiety and serious agitation, for example from feeling threatened, incoherent speech and muddled thinking, confusion, violent or disruptive behaviour and mania. The newer antipsychotics usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. More normal thinking often is restored within a few weeks.

Types of antipsychotics

Antipsychotic drugs tend to fall into one of two categories: first generation (older), or 'typical' antipsychotics and second generation (newer), or 'atypical' antipsychotics. Both types can potentially work for different people. They also have different side effects.

First generation antipsychotics are sometimes referred to as 'typicals'. They divide into various chemical groups which all act in a very similar way and can cause very similar side effects, including severe neuromuscular side effects. But they are not all the same. For example, some may cause more severe movement disorders than others, or be more likely to make you drowsier.

Second generation antipsychotics are sometimes referred to as 'atypicals'. In general, they cause less severe neuromuscular side effects than first generation antipsychotics. Some are also less likely to cause sexual side effects compared to first generation antipsychotics. But second generation antipsychotics may be more likely to cause serious metabolic side effects. This may include rapid weight gain and changes to blood sugar levels.

Side effects

Certain antipsychotic drugs cause significant weight gain and high cholesterol levels, and they may increase the risk of diabetes. People considering an antipsychotic for bipolar disorder should be screened for their risk of heart disease, stroke, and diabetes, according to a study published in Diabetes Care. Common side effects of antipsychotic medications include: Blurred vision, Dry mouth, Drowsiness, Muscle spasms or tremors and Weight gain.

Older antipsychotic drugs are generally not used as a first-line treatment for bipolar disorder, and they are less established for treating depressive symptoms or preventing episodes during long-term use. However, they may be helpful if a person has troublesome side effects or doesn't respond to the newer drugs.

Drugs used as antipsychotics are aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), clozapine (Clozaril), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon).

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Regards

Mary Wilson

Editorial office

Clinical Pharmacology and Toxicology Research

E-mail: pharmatoxicol@eclinicalsci.com