scholarly journals Are Atypical Antipsychotics the Least Detrimental Alternative?

2019 ◽  
Vol 16 (1) ◽  
pp. 91-104
Author(s):  
Holly Breton
Keyword(s):  
Metabolic Syndrome ◽  
Side Effect ◽  
Atypical Antipsychotics ◽  
First Generation ◽  
Extrapyramidal Symptoms ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Second Generation Antipsychotics ◽  
Potential Risks ◽  
Decrease Life Expectancy

Antipsychotics are typically used for the treatment of schizophrenia, bipolar disorder, and recently, treatment resistant major depressive disorder.  A significant, and very concerning, side effect present with first generation antipsychotics is extrapyramidal symptoms, which are disorders of movement. With the advent of atypical antipsychotics, also known as second-generation antipsychotics, these symptoms are purported to be much less frequent and pronounced than they were with the first generation medications.  Numerous hypotheses have been proposed as to why atypical antipsychotics produce fewer extrapyramidal symptoms compared to first generation antipsychotics, which this paper will review. Unfortunately, despite the fact that atypicals have reduced extrapyramidal symptoms in those taking antipsychotics, extrapyramidal symptoms are still an unpleasant and potentially dangerous side effect, which can be difficult to detect, and difficult, or even impossible, to treat.  Additionally, atypical antipsychotics result in other potentially very serious side effects, specifically and most commonly, metabolic syndrome, which can decrease life expectancy significantly. However, metabolic syndrome, unlike extrapyramidal symptoms, may be preventable in highly motivated and well-supported patients. Thus, this paper concludes that the benefits of the atypical antipsychotics (reduced extrapyramidal symptoms) outweigh the potential risks for the majority of patients.

Antipsychotics

2020 ◽  
pp. 121-184
Author(s):  
Arash Ansari ◽  
David N. Osser
Keyword(s):  
Clinical Characteristics ◽  
First Generation ◽  
Black Box ◽  
Brand Names ◽  
Clinical Use ◽  
Childbearing Age ◽  
Medical Disorders ◽  
Second Generation Antipsychotics ◽  
Black Box Warnings ◽  
Potential Risks

The chapter on antipsychotics discusses and reviews the use of first-generation antipsychotics, including haloperidol and chlorpromazine, as well as the use of second-generation antipsychotics, including risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, clozapine, paliperidone, iloperidone, asenapine, lurasidone, brexpiprazole, and cariprazine. Pimavanserin is also discussed. The chapter reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, and potential risks including neuroleptic side effects such as acute dystonias, parkinsonian symptoms, akathisia, and tardive dyskinesia. Metabolic syndrome (which includes risks of weight gain, hyperglycemia, and hyperlipidemias) and cardiac risks are also discussed. The chapter also briefly discusses complementary and alternative pharmacotherapies. It then provides an in-depth review of the clinical use of antipsychotics for psychotic and behavioral disorders, as well as for other nonpsychotic psychiatric and medical disorders. It also discusses the use of antipsychotics in women of childbearing age, notably in regard to pregnancy and breastfeeding considerations. Finally, the chapter includes a table of antipsychotics that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications.

Therapy of Treatment Resistant Depression: Focus on the Management of TRD with Atypical Antipsychotics

CNS Spectrums ◽  
2004 ◽  
Vol 9 (11) ◽  
pp. 823-832 ◽  
Author(s):  
Nikolas Klein ◽  
Julia Sacher ◽  
Helene Wallner ◽  
Johannes Tauscher ◽  
Siegfried Kasper
Keyword(s):  
Atypical Antipsychotics ◽  
Symptom Improvement ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Adequate Treatment ◽  
Resistant Depression ◽  
Operational Criteria ◽  
Definition Of ◽  
Diagnosis Criteria

ABSTRACTTreatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.

scholarly journals Delusional Infestation in a Patient with Renal Failure, Metabolic Syndrome, and Chronic Cerebrovascular Disease Treated with Aripiprazole: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Bernardo Carpiniello ◽  
Federica Pinna ◽  
Raffaella Tuveri
Keyword(s):  
Metabolic Syndrome ◽  
Renal Failure ◽  
Cerebrovascular Disease ◽  
Atypical Antipsychotics ◽  
Medical Conditions ◽  
Psychiatric Condition ◽  
First Line ◽  
Severe Renal Failure ◽  
Second Generation Antipsychotics ◽  
Wide Range

Delusional infestation is an aspecific psychiatric condition manifested either as a primary psychotic disorder or a secondary disorder induced by a wide range of very different medical conditions. Both primary and secondary delusional infestations seem to respond to typical and atypical antipsychotics. The latter are considered the first-line treatment although the use of second-generation antipsychotics featuring a higher metabolic, cardiovascular, and renal tolerability is preferable in secondary cases, which often occur in patients with multiple, severe medical conditions. We report a case of a 72-year-old patient affected by delusional infestation associated with severe renal failure, metabolic syndrome, hypertensive cardiopathy, and chronic cerebrovascular disease.

P01-365 Safety of second-generation antipsychotics in children-questionnaire evaluation in psychiatrists

2011 ◽  
Vol 26 (S2) ◽  
pp. 367-367
Author(s):  
A. Wisniewski ◽  
A. Acewicz ◽  
K. Brewczyk
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotics ◽  
First Generation ◽  
Liver Enzymes ◽  
Safety Monitoring ◽  
Conduct Disorders ◽  
Adverse Side Effects ◽  
Monitoring Strategies ◽  
Second Generation Antipsychotics ◽  
Youth Population

Atypical antipsychotics are more safe than first generation drugs. But some researchers suggest that children and adolescents might be more sensitive than adults to developing antipsychotic-related adverse side effects. The standards of safety monitoring strategies do not exist in Poland.ObjectiveThe aim of this study was to estimate physicians awareness to side effects in youth population treated with antipsychotics.Material20 questionnaires filled up by polish child psychiatrists.MethodInformation from author's questionnaire concerns side effects observed in antipsychotics medicated children, psychiatrists own preferences in safety monitoring strategies were analyzed.ResultsAtypical antipsychotics are used in 25% of medicated children. Risperidon is the most popular antipsychotic in psychotic and non-psychotic indications (81%, 66%), afterwards olanzapine (54%, 30%) and quetiapine (34%, 24%). The most common indications for antipsychotics in children are: tics (55%), conduct disorders (53%) and schizophrenia (45%). Before drug initiation doctors check liver enzymes (GOT, GTP) (98%), hematology (98%), glucose level (95%), weight and height (91%), ECG (90%). The most common side effects observed are: weigh gain (63%), somnolence (59%), prolactin elevation (47%), attention deficits (43%).ConclusionIn spite of lack of safety monitoring standards in youth population psychiatrists seem to be aware and careful in atypical neurolpetic treatment in children.

scholarly journals Risk Factors of Metabolic Syndrome Among Patients Receiving Antipsychotics: A Retrospective Study

2019 ◽  
Vol 56 (4) ◽  
pp. 760-770 ◽  
Author(s):  
Samer Hammoudeh ◽  
Hawra Al Lawati ◽  
Suhaila Ghuloum ◽  
Huma Iram ◽  
Arij Yehya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Body Mass Index ◽  
Retrospective Study ◽  
Mentally Ill ◽  
First Generation ◽  
Clinical Status ◽  
Metabolic Effects ◽  
Retrospective Data ◽  
Second Generation Antipsychotics

AbstractThis study aimed to assess the differential effects of first-generation (FGA) and second-generation antipsychotics (SGA) on the prevalence of risk factors for metabolic syndrome among mentally ill patients in Qatar. We also wanted to check if there is proper adherence with the guidelines for prescribing antipsychotics and the monitoring of metabolic effects in this population. We collected the available retrospective data (socio-demographic, psychiatric, anthropometric, and metabolic measures) from the records of 439 patients maintained on antipsychotics. The majority were males, married, employed, having a psychotic disorder, and receiving SGA. Patients on SGA showed more obesity, higher BP, and more elevated triglycerides compared to those on FGA. The prevalence of the abnormal metabolic measures was high in this sample, but those on SGA showed a significantly higher prevalence of abnormal body mass index and BP. Obesity and hypertension were common in patients maintained on antipsychotics, especially those on SGA. Polypharmacy was common, and many metabolic measures were not monitored properly in those maintained on antipsychotics. More prospective studies with guided monitoring of the patients' clinical status and metabolic changes are needed to serve better this population of patients.

Use of second generation antipsychotics for treatment-resistant major depressive disorder

2014 ◽  
Vol 4 (5) ◽  
pp. 246-256
Author(s):  
Rebecca Waite
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Symptoms ◽  
Adverse Effects ◽  
Depressive Disorder ◽  
Second Generation ◽  
Antidepressant Therapy ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Quetiapine Xr ◽  
Second Generation Antipsychotics

Many of the second generation antipsychotics (SGAs) have been studied as adjunctive agents in the management of treatment-resistant major depressive disorder. Two have also been examined for use as monotherapy for depression. Currently, aripiprazole, olanzapine (in combination with fluoxetine), and quetiapine XR are approved by the FDA for use as adjunctive agents in the treatment of major depressive disorder, and no SGAs are FDA-approved as monotherapy for the disorder. This article reviews the available evidence regarding the use of SGAs in patients with treatment-resistant major depressive disorder and the subsequent role for these agents based on this evidence. There is evidence that aripiprazole, quetiapine, olanzapine, and risperidone can be effective in improving depressive symptoms when added to antidepressant therapy, but the benefits have to be weighed against their risk of producing serious adverse effects.

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