Antipsychotic agent: Difference between revisions
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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."<ref name="pmid19144938">{{Cite journal | |||
| doi = 10.1056/NEJMoa0806994 | |||
| volume = 360 | |||
| issue = 3 | |||
| pages = 225-235 | |||
| last = Ray | |||
| first = Wayne A. | |||
| coauthors = Cecilia P. Chung, Katherine T. Murray, Kathi Hall, C. Michael Stein | |||
| title = Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death | |||
| journal = N Engl J Med | |||
| accessdate = 2009-01-15 | |||
| date = 2009-01-15 | |||
| url = http://content.nejm.org/cgi/content/abstract/360/3/225 | |||
| pmid=19144938 | |||
}}</ref> 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"."<ref name="pmid18755769">{{cite journal |author=Douglas IJ, Smeeth L |title=Exposure to antipsychotics and risk of stroke: self controlled case series study |journal=BMJ |volume=337 |issue= |pages=a1227 |year=2008 |pmid=18755769 |pmc=2526549 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18755769 |issn=}}</ref> | 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"."<ref name="pmid18755769">{{cite journal |author=Douglas IJ, Smeeth L |title=Exposure to antipsychotics and risk of stroke: self controlled case series study |journal=BMJ |volume=337 |issue= |pages=a1227 |year=2008 |pmid=18755769 |pmc=2526549 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18755769 |issn=}}</ref> | ||
Revision as of 10:52, 15 January 2009
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, quetiapine, risperidone, aripiprazole, 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-psychotics amisulpride, clozapine, olanzapine, and risperidone may be the most effect agents for schizophrenia.[4]
Regarding the treatment of delirium, all drugs may have similar efficacy.[5]
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.[5]
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."[6] 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"."[7]
Prolongation of the QT interval may be the most with thioridazine and least with risperidone.[8]
Other effects
Withdrawing psychotropics mediations may prevent falls.[9]
References
- ↑ Anonymous (2024), Antipsychotic agent (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 2.0 2.1 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.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 5.0 5.1 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.
- ↑ 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.
- ↑ 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]
- ↑ Stöllberger C, Huber JO, Finsterer J (September 2005). "Antipsychotic drugs and QT prolongation". Int Clin Psychopharmacol 20 (5): 243–51. PMID 16096514. [e]
- ↑ 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]