Medications for Schizophrenia

Once a diagnosis is made, antipsychotics form the main medications for schizophrenia. The first generation antipsychotics were discovered in the 1950s are still effective in the treatment of psychotic symptoms, but often lead to motor side effects (viz: dystonic reactions, akathisia, parkinsonian symptoms, and tardive dyskinesia). For a broader discussion, see general side effects of antipsychotics and extra pyramidal side effects.

Some of the more common medications are the first generation or typical antipsychotic drugs:
  • haloperidol
  • chlopromazine
  • fluphenazine
  • flupenthixol
  • zuclopenthixol
  • trifluoperazine
  • pimozide
  • perphenanazine
  • sulpiride

Clozapine was the first atypical antipsychotics, and this was developed in the 1960s.

Second generation antipsychotics have been developed in the past 10 years. These have the advantage of causing less motor side effects. Initially there was optimism that they would improve not only the positive symptoms but also the negative and cognitive symptoms . The promise of efficacy against negative and cognitive symptoms has not been borne out. The second generation drugs as a class, have unfortunately a high incidence of metabolic side effects which include weight gain, increased triglycerides (blood fats) and cholesterol. Aripiprazole and zyprasidone have better metabolic profiles within this class.

The second generation antipsychotics are atypical antipsychotics whcih have been developed in the last 10 years. Some of these include:

Other treatments include depot medications which are long-acting injectable preparations. These halperidol decanoate, zuclopentixol, flupenpithixol, fluanxol, piportil and Risperidone Consta. Risperdal Consta is the only newer genration antipsychotic which is available in the UK National Health System as a long-acting depot. Olanzapine is available as a long-acting preparation, but the costs of the medication and the impractacle measure around the administration which includes monitoring the patient for 2 hours afterwards, makes this drug prohibitive. It is also associated with a post injection delirium.

Amisulpiride and clozapine are classed as atypical agents but are not second generation drugs. See the link for further information on clozapine.

Most modern treatment guidelines recommend that a second generation antipsychotic be first line treatment for newly diagnosed schizophrenia

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