Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) [Online Table] Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gardner, D. M. Articles by Waraich, P. Search for Related Content PubMed PubMed Citation Articles by Gardner, D. M. Articles by Waraich, P. Related Collections Drugs: psychiatry

Modern antipsychotic drugs: a critical overview

From the Department of Psychiatry and the College of Pharmacy, Dalhousie University, Halifax, NS (Gardner); Harvard Medical School, and the Psychopharmacology Program, McLean Division of Massachusetts General Hospital, Boston, Mass. (Baldessarini); and the Mental Health Evaluation and Community Consultation Unit, Department of Psychiatry, University of British Columbia, Vancouver, BC (Waraich)

Correspondence to: Dr. David M. Gardner, Queen Elizabeth II Health Sciences Centre, Rm. AJLB 7517, 5909 Veterans Memorial Lane, Halifax NS B3H 2E2; david.gardner{at}dal.ca

Abstract

CONVENTIONAL ANTIPSYCHOTIC DRUGS, used for a half century to treat a range of major psychiatric disorders, are being replaced in clinical practice by modern "atypical" antipsychotics, including aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone among others. As a class, the newer drugs have been promoted as being broadly clinically superior, but the evidence for this is problematic. In this brief critical overview, we consider the pharmacology, therapeutic effectiveness, tolerability, adverse effects and costs of individual modern agents versus older antipsychotic drugs. Because of typically minor differences between agents in clinical effectiveness and tolerability, and because of growing concerns about potential adverse long-term health consequences of some modern agents, it is reasonable to consider both older and newer drugs for clinical use, and it is important to inform patients of relative benefits, risks and costs of specific choices.

This article has been cited by other articles:

				S. Saddichha and M. Kumar Antipsychotic-induced urinary dysfunction: anticholinergic effect or otherwise? BMJ Case Reports, May 21, 2009; 2009(may21_1): bcr0220091547 - bcr0220091547. [Abstract] [Full Text]

				V. M. Linck, A. P. Herrmann, A. L. Piato, B. C. Detanico, M. Figueiro, J. Florio, M. M. Iwu, C. O. Okunji, M. B. Leal, and E. Elisabetsky Alstonine as an Antipsychotic: Effects on Brain Amines and Metabolic Changes Evid. Based Complement. Altern. Med., February 2, 2009; (2009) nep002v1. [Abstract] [Full Text] [PDF]

				I. Schubert and G. Lehmkuhl Increased Antipsychotic Prescribing to Youths in Germany Psychiatr Serv, February 1, 2009; 60(2): 269 - 269. [Full Text] [PDF]

				W. T. Carpenter and R. W. Buchanan Lessons to Take Home From CATIE Psychiatr Serv, May 1, 2008; 59(5): 523 - 525. [Abstract] [Full Text] [PDF]

				S. Alessi-Severini, R. G. Biscontri, D. M. Collins, A. Kozyrskyj, J. Sareen, and M. W. Enns Utilization and Costs of Antipsychotic Agents: A Canadian Population-Based Study, 1996-2006 Psychiatr Serv, May 1, 2008; 59(5): 547 - 553. [Abstract] [Full Text] [PDF]

				K. S. Jarboe Considering the Impact on Overall Patient Health When Choosing Antipsychotic Therapy Journal of the American Psychiatric Nurses Association, November 1, 2007; 13(5_suppl): S23 - S28. [Abstract] [PDF]

				C. A. Tamminga and J. M. Davis The Neuropharmacology of Psychosis Schizophr Bull, July 1, 2007; 33(4): 937 - 946. [Abstract] [Full Text] [PDF]

				N. S. Karnik, S. V. Joshi, C. Paterno, and R. Shaw Subtypes of Pediatric Delirium: A Treatment Algorithm Psychosomatics, June 1, 2007; 48(3): 253 - 257. [Abstract] [Full Text] [PDF]

				N. C. Brahm, S. L. Gutierres, and R. M. Carnahan Quetiapine for acute mania in bipolar disorder Am. J. Health Syst. Pharm., May 15, 2007; 64(10): 1045 - 1053. [Abstract] [Full Text] [PDF]

				C. H. Large Do NMDA receptor antagonist models of schizophrenia predict the clinical efficacy of antipsychotic drugs? J Psychopharmacol, May 1, 2007; 21(3): 283 - 301. [Abstract] [PDF]

				A. V. Terry Jr. and S. P. Mahadik Time-Dependent Cognitive Deficits Associated with First and Second Generation Antipsychotics: Cholinergic Dysregulation as a Potential Mechanism J. Pharmacol. Exp. Ther., March 1, 2007; 320(3): 961 - 968. [Abstract] [Full Text] [PDF]

				T. L Bettinger, G. Shuler, D. R Jones, and J. P Wilson Schizophrenia: Multi-Attribute Utility Theory Approach to Selection of Atypical Antipsychotics Ann. Pharmacother., February 1, 2007; 41(2): 201 - 207. [Abstract] [Full Text] [PDF]

				P. S. Masand Differential pharmacology of atypical antipsychotics: Clinical implications Am. J. Health Syst. Pharm., January 15, 2007; 64(2_Supplement_1): S3 - S8. [Abstract] [Full Text] [PDF]

				A. K. Bothe, J. H. Davidow, R. E. Bramlett, D. M. Franic, and R. J. Ingham Stuttering Treatment Research 1970-2005: II. Systematic Review Incorporating Trial Quality Assessment of Pharmacological Approaches. Am J Speech Lang Pathol, November 1, 2006; 15(4): 342 - 352. [Abstract] [Full Text] [PDF]

				M. D. Llorente and V. Urrutia Diabetes, Psychiatric Disorders, and the Metabolic Effects of Antipsychotic Medications Clin. Diabetes, January 1, 2006; 24(1): 18 - 24. [Abstract] [Full Text] [PDF]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2005, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.