title: Current use of atypical antipsychotics.
abstract: In terms of the phenomenology of schizophrenia, there are four targets for drug treatments: positive symptoms, negative symptoms, affective dysfunction, and cognitive dysfunction. Because of the side-effects of both conventional antipsychotics and the new atypicals, there still is a need to search for better-tolerated antipsychotics. Conventional antipsychotics have two principal limitations: 30-40% of patients have an insufficient response to them, and they have a large variety of adverse effects. Side-effects will reduce patients' compliance with treatment, as well as their immediate quality of life, and may therefore unfavorably affect rehabilitation. Four principal features differentiate atypical from conventional antipsychotics, yet have not been established for all atypicals: fewer extrapyramidal side-effects, greater efficacy in the treatment of negative symptoms, specific pharmacological receptor binding profiles, and greater selective effect on the mesolimbic dopamine neurons than on nigrostriatal neurons. The pharmacological profile of amisulpride is completely different to that of other atypical antipsychotics. It has a high selectivity for D2 and D3 dopamine receptors, and thus would be expected to be devoid of unwanted side-effects associated with action on other neurotransmitter systems. It acts preferentially on the mesocortical and mesolimbic systems. It has an earlier onset of action than haloperidol. Amisulpride is a compound with a dual mode of action. At low doses it blocks presynaptic dopamine autoreceptors, inducing an increased dopaminergic neurotransmission, and at high doses it blocks postsynaptic dopaminergic activity. It is at least as effective as haloperidol, flupenthixol, and risperidone in controlling positive symptoms, as well as having efficacy for negative symptoms. It has less propensity to induce weight gain than do other atypical antipsychotics. For the 60-80% of patients with schizophrenia who require long-term treatment, drug tolerability is crucially important, as it will improve compliance, and therefore reduce relapse rate.
authors.affiliation: Psychiatric Hospital, University of Basel, Wilhelm Klein-Strasse 27, CH-4025 Basel, Switzerland. franz.mueller-spahn@pukbasel.ch
authors.forename: F
authors.initials: F
authors.lastname: Müller-Spahn
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017660:Autoreceptors / Q000187:drug effects; D001921:Brain / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005475:Flupenthixol / Q000009:adverse effects / Q000627:therapeutic use; D006220:Haloperidol / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D055118:Medication Adherence; D017448:Receptors, Dopamine D2 / Q000187:drug effects; D050637:Receptors, Dopamine D3 / Q000187:drug effects; D017661:Receptors, Presynaptic / Q000187:drug effects; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D009435:Synaptic Transmission / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D017660:Autoreceptors; D017448:Receptors, Dopamine D2; D050637:Receptors, Dopamine D3; D017661:Receptors, Presynaptic; D005475:Flupenthixol; D006220:Haloperidol; D018967:Risperidone