2nd generation atypical antipsychotics provide physicians with therapeutic options tha patients prefer

Main Category: Schizophrenia
Article Date: 20 Jul 2004 - 12:00 PDT

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The second generation atypical antipsychotics provide physicians with therapeutic options that patients generally find more tolerable than first generation agents. Early intervention and medication adherence are strongly associated with best long-term outcomes.

Schizophrenia affects about 2.2 million Americans, roughly 1% of the population, with most cases developing in individuals between the ages of 16 and 30. The often debilitating symptoms can limit the ability of those with schizophrenia to interact with other people and cope with life situations. Individuals with schizophrenia have an increased risk of early death, with suicide being the leading cause. There is evidence that those with schizophrenia are more susceptible to disease and infections, have higher accident rates, and are more prone to substance abuse.

Antipsychotic medications to reduce symptoms became available in the 1950s. These were generally more effective controlling positive symptoms (delusions, hallucinations) than negative ones (dulled emotions, speech changes). This first generation of drugs often produced unpleasant side effects including tardive dyskinesia (TD), a movement disorder affecting the face and extremities.

"These drugs, although effective, have been severely limited by an extremely distressing and potentially pernicious side effect profile, mainly producing neurologic side effects of the extrapyramidal system." explains Jeffrey A. Lieberman, MD. "The big breakthrough in this class of pharmacotherapy occurred with the introduction of clozapine in 1989, which was a prototype of a newer form of antipsychotic medication. It was different, and in some ways better, by virtue of the fact that it was therapeutic like the older medicines and it did not produce anywhere near the same level of severity or frequency the neurologic side effects. You can analogize to the older cancer chemotherapy drugs. People had to take them because the alternative was obviously not an option, so this justified the tolerance of the very high levels of serious side effects. The second generation drugs put that dire situation behind us where you were between a rock and a hard place, therapeutically speaking."

Now a class of a half dozen, the atypical antipsychotics are as effective as the older agents in reducing positive symptoms, while being more tolerable and perhaps better in relieving schizophrenia's negative symptoms. Of this group, Dr. Lieberman says, "It has been perceived and hypothesized that in addition to a better standard of safety, they may have some additional advantages in efficacy as well. They are somewhat more effective than the older medicines for psychosis. They give a broader range of therapeutic effects on other aspects of schizophrenia, such as cognitive impairment, relapse prevention, and suicidal behavior." CONTINUES.....................www.physweekly.com

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