Summary
Current usage of the term ‘atypical’ in relation to antipsychotics lacks clear theoretical underpinnings and rigour in application. The prevailing definition of atypicality is a reduced liability to induce extrapyramidal side effects (EPS). However, this definition appears incomplete in the face of numerous other limitations associated with antipsychotics that can impact adversely on patient well-being; these encompass issues of efficacy, non-motoric physiology and quality of life.
On this basis, more conservative, operationalised criteria for atypical antipsychotic activity can be offered and applied to representative classical versus more recently introduced antipsychotics. These criteria include a reduced liability to induce EPS, but also superior efficacy, efficacy in patients who do not respond to classical antipsychotics, and no induction of subjective dysphoria, sedation, autonomic/cardiac effects, sexual dysfunction and bodyweight gain, and no elevation of prolactin levels or other endocrine effects. Such criteria codify yet higher aspirations for treatment with the welcome array of newer agents that is currently emerging.
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References
Deniker P. Discovery of the clinical use of neuroleptics. In: Parnham MJ, Bruinvels J, editors. Discoveries in pharmacology, vol 1. Psycho- and neuro-pharmacology. Amsterdam: Elsevier, 1983: 163–80
Baldessarini RJ. Drugs and the treatment of psychiatric disorders. In: Gilman AG, Goodman LS, Rail TW, et al., editors. Goodman and Gilman’s the pharmacological basis of therapeutics. New York: MacMillan, 1985: 387–445
Meltzer HY. Atypical antipsychotic drugs. In: Bloom FE, Kupfer DJ, editors. Psychopharmacology: the fourth generation of progress. New York: Raven Press, 1995: 1277–86
Pickar D. Prospects for pharmacotherapy of schizophrenia. Lancet 1995; 345: 557–62
Gerlach J, Casey DE. Drug treatment of schizophrenia: myths and realities. Curr Opin Psychiatry 1994; 7: 65–70
Kane JM. Drug therapy: schizophrenia. N Engl J Med 1996; 334: 34–41
Meltzer HY. Atypical antipsychotic drug therapy for treatment-resistant schizophrenia. In: Hirsch SR, Weinberger DR, editors. Schizophrenia. Oxford: Blackwell, 1995: 485–502
Owens DGC. Adverse effects of antipsychotic agents: do newer agents offer advantages? Drugs 1996; 51: 895–930
McCreadie RG, Todd N, Livingston M, et al. A double blind comparative study of remoxipride and thioridazine in the acute phase of schizophrenia. Acta Psychiatr Scand 1988; 78: 49–56
Keks N, McGrath J, Lambert T, et al. The Australian multicentre double-blind comparative study of remoxipride and thioridazine in schizophrenia. Acta Psychiatr Scand 1994; 90: 358–65
Carpenter WT, Buchanan RW. Schizophrenia. N Engl J Med 1994; 330: 681–90
Waddington JL. The clinical psychopharmacology of antipsychotic drugs in schizophrenia. In: Hirsch SR, Weinberger DR, editors. Schizophrenia. Oxford: Blackwell, 1995: 341–57
Schulz SC, Buckley PF. Treatment-resistant schizophrenia. In: Hirsch SR, Weinberger DR, editors. Schizophrenia. Oxford: Blackwell, 1995: 469–84
Awad GA. Subjective response to neuroleptics in schizophrenia. Schizophr Bull 1993; 19: 609–16
Goff DC, Shader RI. Non-neurological side effects of antipsychotic agents. In: Hirsch SR, Weinberger DR, editors. Schizophrenia. Oxford: Blackwell, 1995: 566–84
Bitton R, Schneider B. Endocrine, metabolic and nutritional effects of psychotropic drugs. In: Kane JM, Lieberman JA, editors. Adverse effects of psychotropic drugs. New York: Guildford Press, 1992: 341–55
Rojansky N, Wang K, Halbreich U. Reproductive and sexual adverse effects of psychotropic drugs. In: Kane JM, Lieberman JA, editors. Adverse effects of psychotropic drugs. New York: Guilford Press, 1992: 356–75
Waddington JL. Schizophrenia, affective psychosis and other disorders treated with neuroleptic drugs: the enigma of tardive dyskinesia, its neurobiological determinants and the conflict of paradigms. Int Rev Neurobiol 1989; 31: 297–353
Thompson C. Concensus statement: the use of high dose antipsychotic medication. Br J Psychiatry 1994; 164: 448–58
Pisciotta AV. Hematological reactions associated with antipsychotic drugs. In: Kane JM, Lieberman JA, editors. Adverse effects of psychotropic drugs. New York: Guilford Press, 1992: 376–94
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Waddington, J.L., O’Callaghan, E. What Makes an Antipsychotic ‘Atypical’?. CNS Drugs 7, 341–346 (1997). https://doi.org/10.2165/00023210-199707050-00001
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DOI: https://doi.org/10.2165/00023210-199707050-00001