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First-line atypical antipsychotics for schizophrenia are appropriate – with psychosocial interventions

  • A. M. Mortimer (a1)
Extract

Conventional antipsychotics, historically the mainstay of schizophrenia treatment, were ineffective in many patients, at least 30% fitting treatment-resistance criteria (Kane & Lieberman, 1987). All had the same mechanism of action: none was any more effective in the individual than any other. Therapeutic nihilism accepted poorly controlled positive symptoms and disabling negative symptoms: nearly all patients suffered side-effects (Barnes & Edwards, 1993), particularly extrapyramidal side-effects (EPS) and hyperprolactinaemia. Conventional antipsychotics raise prolactin to a range associated with sexual dysfunction or even macroprolactinoma: effects in men include erectile dysfunction and hypospermatogenesis; in women, galactorrhoea, oligo- or amenorrhoea, hirsutism and increased risk of osteoporosis. In both men and women there is loss of libido, and a link between hyperprolactinaemia and weight gain.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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ADAMS, C. & NHS Centre for Reviews and Dissemination (1999) Drug treatments for schizophrenia. Effective Health Care Bulletin, 5, No 6.
Awad, A. G. (1995) Quality of life in medicated schizophrenics: therapeutic and research implications. In: Contemporary Issues in the Treatment of Schizophrenia, (eds Shriqui, C. & Nasrallah, H.), pp. 735747. Washington, USA: American Psychiatric Press.
Barnes, T. R. E. & Edwards, J. (1993) Antipsychotic Drugs and their Side Effects. London: Academic Press.
Berardi, D., Gianelli, A., Biscione, R., et al (2000) Extrapyramidal symptoms and residual psychopathology with low-dose neuroleptics. Human Psychopharmacology, 15, 7986.
Caliguiri, M., Lohr, J. B. & Jeste, D. V. (1993) Parkinsonism in neuroleptic naive schizophrenic patients. American Journal of Psychiatry, 150, 13431348.
Davis, J. M., Metalon, L., Watanabe, M. D., et al (1994) Depot antipsychotic drugs: place in therapy. Drugs, 47, 741773.
Green, M. F. (1996) What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153, 321330.
Harvey, P. D. & Keefe, R. S. E. (1998) Cognition and the new antipsychotics. Journal of Advances in Schizophrenia and Brain Research, 1, 28.
Johnson, D. A. W. (1988) Drug treatment of schizophrenia. In: Schizophrenia: The Major Issues. (eds Bebbington, P., & McGuffin, P.). Oxford: Heinemann Professional Publishing.
Kane, J. & Lieberman, J. A. (1987) Maintenance pharmacotherapy in schizophrenia. In: Psychopharmacology The Third Generation of Progress: The Emergence of Molecular Biology and Biological Psychiatry. (ed. Meltzer, H. Y.), pp. 11031109. New York: Raven Press.
Kane, J., Honigfeld, G. & Singer, J. (1988) Clozapine for the treatment resistant schizophrenic: a double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789796.
Leucht, S., Pitschel-Walz, G., Abraham, D., et al (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, 5168.
Lieberman, J. A. (1996) Atypical antipsychotic drugs as a first-line treatment of schizophrenia: a rationale and hypothesis. Journal of Clinical Psychiatry, 57, 6871.
Phillips, L. J., Yung, A. R., Hearn, N., et al (1999) Preventative mental health care: accessing the target population. Australian and New Zealand Journal of Psychiatry, 33, 912917.
Stahl, S. M. (1999) Selecting an atypical antipsychotic by combining clinical experience with guidelines from clinical trials. Journal of Clinical Psychiatry, 60, 3141.
Zimbroff, D. L., Kane, J. M., Tamminga, C. A., et al (1997) Controlled, dose–response study of sertindole and haloperidol in the treatment of schizophrenia. American Journal of Psychiatry, 154, 782791.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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First-line atypical antipsychotics for schizophrenia are appropriate – with psychosocial interventions

  • A. M. Mortimer (a1)
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