Antipsychotics , also known as neuroleptic or main sedative , is a class of drugs primarily used to manage psychosis (including delusions, hallucinations, paranoia or disorders thought), especially in schizophrenia and bipolar disorder. They are increasingly being used in the management of non-psychotic disorders. Antipsychotics are usually effective in reducing the symptoms of psychosis in the short term.
Long-term use of antipsychotics is associated with side effects such as uncontrolled movement disorders, gynecomastia, and metabolic syndrome. They are also associated with increased mortality in elderly people with dementia.
The first-generation antipsychotics, known as typical antipsychotics, were discovered in the 1950s. Most second-generation drugs, known as atypical antipsychotics, have been developed recently, although the first atypical antipsychotic, clozapine, was discovered in 1960 and was introduced clinically in the 1970s. Both generations of treatment tend to block receptors in the brain dopamine pathway, but atypicals tend to act on serotonin receptors as well. Neuroleptic , derived from the Greek: "??????" ( neuron ) and "????? ??" ( holding ) - thereby meaning "taking nerves" - refers to common neurological effects and side effects.
Video Antipsychotic
Medical use
Antipsychotics are most commonly used for the following conditions:
- Schizophrenia
- Schizoaffective disorders are most commonly associated with antidepressants (in the case of depressed subtypes) or mood stabilizers (in the case of bipolar subtypes).
- Bipolar disorder (acute mania and mixed episodes) may be treated with typical or atypical antipsychotics, although atypical antipsychotics are usually preferred because they tend to have a more favorable side-effect profile and, according to a recent meta-analysis, they tend to have lower liability because it causes the conversion from mania to depression.
- Psychotic depression. In this indication it is a common practice for psychiatrists to prescribe a combination of atypical and antidepressant antipsychotics because this practice is best supported by evidence.
- Major depression that is resistant to treatment (and not necessarily psychotic) as standard antidepressant therapy.
They are not recommended for dementia or insomnia unless other treatments are unsuccessful. They are not recommended in children unless other treatments are ineffective or unless the child has psychosis.
The World Health Organization provides a description of recommendations for antipsychotic prescriptions for the purpose of psychosis treatment.
Schizophrenia
Treatment of antipsychotic drugs is a key component of the schizophrenic treatment algorithm recommended by the National Institute of Health and Nursing Excellence (NICE), the American Psychiatric Association, and the British Society for Psychopharmacology. The main effect of treatment with antipsychotics is to reduce the so-called "positive" symptoms, including delusions and hallucinations. There is ample evidence to support the significant impact of antipsychotic use on negative symptoms (such as apathy, lack of emotional influence, and lack of interest in social interactions) or on cognitive symptoms (irregular thinking, reduced ability to plan and execute tasks) schizophrenia. In general, the efficacy of antipsychotic treatment in reducing both positive and negative symptoms seems to increase with increasing severity of early symptoms.
The application of antipsychotic drugs in the treatment of schizophrenia includes prophylaxis in those with symptoms suggesting that they are at high risk of developing psychosis, first episode psychotic treatment, maintenance therapy, and treatment of recurrent episodes of acute psychosis.
Psychosis prevention and symptom improvement
Battery tests such as PACE (Personal Assessment and Clinical Crisis Evaluation), which measure low-level psychotic symptoms, and others focus on cognitive impairment (Basic symptoms), are used to evaluate people early, low-level symptoms of psychosis. Used in combination with family history information, this test can identify "high-risk" groups who have a 20-40% risk of development to an honest psychosis within 2 years. These patients are often treated with low doses of antipsychotic drugs with the aim of reducing their symptoms and preventing progression to bright psychosis. While generally useful for reducing symptoms, clinical trials conducted to date provide little evidence that early use of antipsychotics, alone or in combination with cognitive-behavioral therapy, provides an increased long-term outcome in those with prodromal symptoms.
First episode psychosis
NICE recommends that all people experiencing the first episode of honest psychosis are treated with antipsychotic drugs and cognitive-behavioral therapy (CBT). NICE further recommends that those who express preferences for CBT alone are told that combination treatment is more effective. The diagnosis of schizophrenia is not usually made at this time, as up to 25% of those who experience first episode psychosis are finally found to suffer from bipolar disorder. The patient's treatment goals include reducing symptoms and potentially improving long-term treatment outcomes. Randomized clinical trials have provided evidence for the efficacy of antipsychotic drugs in achieving prior goals, with first generation and second generation antipsychotics demonstrating the same efficacy. The evidence that early treatment has a beneficial effect on long-term outcomes is vague.
Repeated psychotic episodes
Placebo-controlled trials of both first and second generation antipsychotic drugs have consistently demonstrated the superiority of active drugs for placebo in suppressing psychotic symptoms. A large meta-analysis of 38 antipsychotic drug trials in an acute psychotic episode of schizophrenia showed an effect size of about 0.5. There was little or no difference in efficacy among approved antipsychotic drugs, including first and second generation agents. The efficacy of these drugs is less than optimal. Some patients achieve complete symptom resolution. The response rate, calculated using various cutoff values ​​for symptom reduction, is low and the interpretation is complicated by high rates of placebo response and clinical selection of clinical results.
Maintenance therapy
Most patients treated with antipsychotic drugs will respond within 4 weeks. The goal of ongoing treatment is to maintain symptom suppression, prevent relapse, improve quality of life, and support involvement in psychosocial therapies.
Maintenance therapy with antipsychotic drugs is clearly superior to placebo in preventing recurrence, but is associated with weight gain, impaired motion, and high dropout rates. Trial 3 years after people who received maintenance therapy after an acute psychotic episode found that 33% experienced long-term symptom degradation, 13% achieved remission, and only 27% experienced a satisfactory quality of life. The effects of relapse prevention on long-term outcomes are uncertain, as historical research shows little difference in long-term outcomes before and after the introduction of antipsychotic drugs.
A significant challenge in the use of antipsychotic drugs for relapse prevention is poor adherence. Despite the relatively high levels of side effects associated with these drugs, some evidence, including higher rates of dropout in the placebo group compared with treatment groups in randomized clinical trials, showed that most patients who discontinued treatment did so because of suboptimal efficacy.
Bipolar disorder
Antipsychotics are routinely used, often simultaneously with mood stabilizers such as lithium/valproate, as first-line treatment for manic episodes and mixtures associated with bipolar disorder. The reason for this combination is delayed therapy from the previously mentioned mood stabilizers (for valproate therapy effects usually seen about five days after starting treatment whereas lithium usually takes at least one week before the complete therapeutic effect is seen) and the relatively fast antimanic effects of antipsychotic drugs. Antipsychotics have documented efficacy when used alone in acute episodes of mania/mixture.
Three atypical antipsychotics (lurasidone, olanzapine and quetiapine) were also found to have efficacy in the treatment of bipolar depression as monotherapy. Whereas only olanzapine and quetiapine have been shown to be broad-spectrum effective (ie against all three types of relapse - beads, mixed and depressed) prophylactic treatment (or maintenance) in patients with bipolar disorder. A Cochrane review recently also found that olanzapine has a less favorable risk/benefit ratio than lithium as a maintenance treatment for bipolar disorder.
The American Psychiatric Association and the UK National Institute for Health and Care Excellence recommend antipsychotics to manage acute psychotic episodes in schizophrenia or bipolar disorder, and as long-term maintenance treatments to reduce the likelihood of subsequent episodes. They suggest that responses to certain antipsychotics may vary so that trials may be necessary, and that lower doses should be preferred if possible. Numerous studies have looked at the level of "compliance" or "adherence" to antipsychotic regimens and found that patients stopped (stopped taking) were associated with higher recurrence rates, including hospitalization.
Dementia
Assessment for underlying causes of behavior is required before prescribing antipsychotic drugs for dementia symptoms. Antipsychotics in old age dementia show modest benefits compared to placebo in managing aggression or psychosis, but this is combined with a considerable increase in serious adverse events. Thus, antipsychotics should not be used routinely to treat dementia with aggression or psychosis, but may be an option in some cases where there is heavy pressure or risk of physical injury to others. Psychosocial intervention can reduce the need for antipsychotics.
Unipolar depression
A number of atypical antipsychotics have some benefits when used in addition to other treatments in major depressive disorders. Aripiprazole, quetiapine, and olanzapine (when used in conjunction with fluoxetine) have received the Food and Drug Administration (FDA) label for this indication. However, there is a greater risk of side effects with its use.
More
Besides the above using antipsychotics can be used for obsessive-compulsive disorder, post-traumatic stress disorder, personality disorder, Tourette's syndrome, autism and agitation in those with dementia. However, the evidence does not support the use of atypical antipsychotics in eating disorders or personality disorders. Risperidone may be useful for obsessive-compulsive disorder. The use of low doses of antipsychotics for insomnia, while common, is not recommended because there is little evidence of benefit and concern about side effects. Low-dose antipsychotics can also be used in the treatment of symptoms of impulse-behavioral and cognitive-percept personality disorder thresholds.
In children they can be used on those with disruptive behavioral disorders, mood disorders and pervasive developmental disorders or intellectual disabilities. Antipsychotics are only recommended for Tourette's syndrome, because although effective, side effects are common. The situation is similar to the autism spectrum. Many of the evidence for the use of antipsychotics off-label (eg, for dementia, OCD, PTSD, Personality Disorders, Tourette) is insufficient scientific qualities to support such use, especially as there is strong evidence of increased risk of stroke, tremors, significant weight gain, sedation, and gastrointestinal problems. The UK review of unlicensed use in children and adolescents reports a mixture of similar findings and concerns. A survey of children with pervasive developmental disorders found that 16.5% used antipsychotic drugs, most often for irritability, aggression, and agitation. Risperidone has been approved by the US FDA for the treatment of irritability in children with autism and adolescence.
Aggressive challenging behavior in adults with intellectual disability is often treated with antipsychotic medication although it has no evidence base. A recent randomized controlled trial, however, found no benefit over placebo and recommended that antipsychotic use in this way should no longer be considered an acceptable routine treatment.
Typical versus atypical
It is not clear whether atypical (second generation) antipsychotics offer advantages over older first generation antipsychotics. Amisulpride, olanzapine, risperidone, and clozapine may be more effective but are associated with larger side effects. Typical antipsychotics have the same drop-out and symptom relapse rates that are atypical when used at low to moderate doses.
Clozapine is an effective treatment for those who respond poorly to other drugs ("resistant" or "refractory schizophrenia"), but has a serious side effect of agranulocytosis (lowered white blood cell count) in less than 4% of people..
Because of the bias in the study, the accuracy of atypical antipsychotic comparisons is of concern.
In 2005, a US government agency, the National Institute of Mental Health published major independent research results (CATIE project). No other atypical studies (risperidone, quetiapine, and ziprasidone) were better than perphenazine at the used size, nor did it produce less adverse effects than typical antipsychotic perphenazine, although more patients stopped perphenazine due to extrapyramidal effects compared to atypical agents. (8% vs. 2% to 4%).
Compliance has not been shown to differ between the two types.
Many researchers are questioning typical atypical first-line recipes, and some even question the differences between the two classes. In contrast, other investigators show a higher risk of tardive dyskinesia and other extrapyramidal symptoms typically and for this reason alone recommend atypical first-line treatment, despite the greater tendency to metabolic side-effects in the latter. British governmental organizations GOOD recently revised atypical support recommendations, to suggest that choice should be one individual based on the specific profile of each drug and on patient preferences.
Re-evaluation of evidence may not necessarily slow down the bias toward atypical prescriptions.
Maps Antipsychotic
Adverse effects
Generally, more than one antipsychotic drug should not be used at a time due to the adverse side effects.
Very rare antipsychotics can cause tardif psychosis.
With rate
- Common (> = 1% and occurrences up to 50% for mostly antipsychotic drugs) adverse antipsychotic effects including
- Sedation (especially common with asenapine, clozapine, olanzapine, quetiapine, chlorpromazine and zotepine)
- Headaches
- Dizzy
- Diarrhea
- Anxiety
- Extrapyramidal side effects (especially common with first generation antipsychotics), which include:
- - Akathisia - an often sad feeling of inner restlessness.
- - Dystonia
- - Parkinsonism
- - Tremor
- Hyperprolactinaemia (rare in those treated with clozapine, quetiapine and aripiprazole), which may cause:
- - Galactorrhoea - Unusual secretion of breast milk.
- - Gynaecomastia
- - Sexual dysfunction (in both genders)
- - Osteoporosis
- Orthostatic hypotension
- Weight gain (especially prominent with clozapine, olanzapine, quetiapine and zotepine)
- Anticholinergic side effects (common for olanzapine, clozapine; less likely on risperidone) such as:
- - Blurred vision
- - Constipation
- - The mouth is dry (although hypersalivation can also occur)
- - Reduces perspiration
- Tardive dysinesia appears to be more frequent with potentially high first-generation antipsychotics, such as haloperidol, and tends to appear after chronic and non-acute treatment. It is characterized by a repetitive, accidental and purposeless, repetitive, repetitive motion, most often on the face, lips, legs, or bodies, which tend to resist treatment and is often irreversible. The rate of appearance of BP is about 5% per year of antipsychotic drug use (whatever medication is used).
- Rare/Rare (& lt; 1% incidence for mostly antipsychotic medication) adverse antipsychotic effects including
- Blood discrasia (eg, agranulocytosis, leukopaenia, and neutropaenia), which is more common in patients with clozapine.
- - Causes weight gain by fighting histamine H 1 and 5-HT serotonin receptors 2C and possibly by interacting with other neurochemical pathways in central nerve system.
- Neuroleptic malignant syndrome is a potentially fatal condition characterized by:
- - Autonomous instability, which can manifest with tachycardia, nausea, vomiting, diaphoresis, etc.
- - Hyperthermia - an increase in body temperature.
- - Changes in mental status (confusion, hallucinations, commas, etc.)
- - Muscle stiffness
- - Laboratory abnormalities (eg, increased creatine kinase, decreased iron plasma levels, electrolyte abnormalities, etc.)
- Pancreatitis
- prolonged QT interval - more prominent in those treated with amisulpride, pimozide, sertindole, thioridazine and ziprasidone.
- Torsades de Pointes
- Seizures, particularly in people treated with chlorpromazine and clozapine.
- Thromboembolism
- Myocardial infarction
- Stroke
Long-term effects
Several studies have found a decrease in life expectancy associated with antipsychotic use, and argues that more research is needed. Antipsychotics can also increase the risk of premature death in individuals with dementia. Antipsychotics usually worsen symptoms in people suffering from depersonalization disorders. Polypharmate antipsychotics (prescribing two or more antipsychotics at the same time for individuals) is a common but not evidence-based or recommended practice, and there are initiatives to reduce it. Similarly, excessively high doses (often the result of polypharmacy) continue despite clinical guidance and evidence suggesting that it is usually no more effective but usually more dangerous.
The loss of gray matter and changes in other brain structures from time to time is observed in schizophrenia. Meta-analysis of antipsychotic treatment effects in the course of gray matter loss and structural changes have reached conflicting conclusions. A 2012 meta-analysis concluded that gray matter loss was greater in patients treated with first-generation antipsychotics relative to those treated with atypical, and hypothesized the effects of atypical protection as one possible explanation. A second meta-analysis suggested that treatment with antipsychotics was associated with an increase in gray matter loss.
A smooth and durable form of akathisia is often overlooked or confused with postpartum depression, especially when they lack the extra pyramidal aspect that psychiatrists have taught to expect when looking for signs of akathisia.
Withdrawal
Symptoms of withdrawal from antipsychotics may occur during dose reduction and discontinuation. Withdrawal symptoms may include nausea, vomiting, anorexia, diarrhea, rhinorrhea, diaphoresis, myalgia, paresthesias, anxiety, dysphoria or depression, cognitive dysfunction, worsening of negative symptoms, agitation, anxiety, and insomnia. Symptoms of psychological withdrawal may be misinterpreted as a relapse of the underlying disorder. Better withdrawal syndrome management can improve the individual's ability to stop antipsychotics.
Unexpected psychotic episodes have been observed in patients who withdrew from clozapine. This is referred to as supersensitive psychosis, not to be confused with tardif psychosis.
Typical discinesia may subside during withdrawal from antipsychotic agents, or may persist.
Withdrawal of the effects can also occur when a person switches from one antipsychotic to another, (it is thought to be due to variations in potential and receptor activity). Such withdrawal effects may include cholinergic rebounds, activation syndromes, and motor syndromes including dyskinesia. These side effects are more likely to occur during rapid changes between antipsychotic agents, thereby making gradual changes between antipsychotics minimize this withdrawal effect. The British National Formulary recommends gradual withdrawal when stopping antipsychotic treatment to avoid acute withdrawal syndrome or rapid relapse. The cross-titration process involves gradually increasing the dose of new drugs while gradually reducing the dose of the old drug.
List of agents
The antipsychotic drugs used clinically are listed below by the drug group. Trade names appear in parentheses. Overview 2013 has stated that the distribution of antipsychotics to first and second generation may be inaccurate.
Catatan:
shows drugs that are no longer (or never) marketed in English-speaking countries.
? shows drugs that are no longer (or never started) marketed in the United States. Some antipsychotics are not placed correctly in first or second generation classes.
# shows the drugs that have been pulled around the world.
First generation (typical)
Butyrophenones
- Benperidol ?
- Bromperidol
- Droperidol ?
- Haloperidol
- Moperone ( stopped )
- Pipamperone ( terminated )
- Timiperon
Diphenylbutylpiperidines - Fluspirilene?
- Penfluridol?
- Pimozide
Phenothiazines
- Acepromazine - though mostly used in veterinary medicine.
- Chlorpromazine
- Cyamemazine
- Dixyrazine
- Fluphenazine
- Levomepromazine ?
- Mesoridazine ( discontinued )
- Perazine
- Pericyazine ?
- Perphenazine
- Pipotiazine ?
- Prochlorperazine
- Promazine ( terminated )
- Promethazine
- Prothipendyl
- Thioproperazine ? (only English-speaking countries are available in Canada)
- Thioridazine ( terminated )
- Trifluoperazine
- Triflupromazine ( terminated )
Thioxanthenes
- Chlorprothixene
- Clopenthixol
- Flupentixol ?
- Thiothixene
- Zuclopenthixol ?
Dispute/unknown
Antipsychotic drugs such as haloperidol and chlorpromazine tend to block the prescription of dopamine D 2 in the dopaminergic brain pathway. This means that the dopamine released in this pathway has fewer effects. Excess dopamine in the mesolimbic pathway has been associated with psychotic experience. The decrease in dopamine release in the prefrontal cortex, and excessive release of dopamine in other pathways, is associated with psychotic episodes in schizophrenia and bipolar disorder. In addition to the antagonistic effects of dopamine, antipsychotics (especially atypical neuroleptics) are also hostile to 5-HT receptors 2A . Different alleles from the 5-HT sub-recipes 2A have been linked to schizophrenia and other psychosis, including depression. The higher concentrations of the 5-HT sub-receptors <2> in the cortical and subcortical regions, especially in the right caudate nucleus have been recorded historically. This is the same receptor that is cured by psychedelic drugs to varying degrees, which explains the correlation between psychedelic drugs and schizophrenia.
Typical antipsychotics are not very selective and also block dopamine receptors in mesocortical pathways, tuberoinfundibular pathways, and nigrostriatal pathways. Blocking D 2 receptors in this other pathway is thought to produce some of the unwanted side effects that ordinary antipsychotics can produce (see above). They are generally classified on low potential spectrum for high potency, where potential refers to the drug's ability to bind to dopamine receptors, rather than the effectiveness of the drug. High-potency antipsychotics such as haloperidol, in general, have doses of several milligrams and cause less drowsiness and soothing effects than low-potency antipsychotics such as chlorpromazine and tioridazine, which have a dose of several hundred milligrams. The latter have higher levels of anticholinergic and antihistaminergic activity, which can counteract dopamine-related side effects.
Atypical antipsychotic drugs have the same blocking effect on D 2 receptors, however, most also work on serotonin receptors, especially 5-HT 2A and 5-HT 2C receptor. Both clozapine and quetiapine appear to bind long enough to induce antipsychotic effects but not long enough to induce extrapyramidal side effects and prolactin hypersecretion. The 5-HT 2A antagonism increases dopaminergic activity in the nigrostriatal pathway, leading to decreased extrapyramidal side effects among atypical antipsychotics.
Drug comparison
History
The original antipsychotic drugs occurred mostly by chance and then tested for their effectiveness. The first, chlorpromazine, is developed as surgical anesthesia. It was first used in psychiatric patients because of its strong calming effect; at the time was considered a non-permanent "pharmacological lobotomy". Lobotomy at the time was used to treat many behavioral disorders, including psychosis, although the effect was to reduce the mental behavior and function of all kinds. However, chlorpromazine has been shown to reduce the effects of psychosis in a more effective and specific way than lobotomy, although known to cause severe sedation. The underlying neurochemistry involved has since been studied in detail, and subsequent antipsychotic drugs have been discovered by an approach that combines this kind of information.
The discovery of the psychoactive effects of chlorpromazine in 1952 led to greatly reduced use of restraint, isolation, and sedation in the management of restless patients, and also led to further studies which resulted in the development of antidepressants, anxiolytics, and the majority of other drugs now. used in the management of psychiatric conditions. In 1952, Henri Laborit described chlorpromazine as just an indifference to what was happening around them in nonpsychotic, nonmanic patients, and Jean Delay and Pierre Deniker described it as controlling manic or psychotic agitation. The former claimed to have found treatment for agitation on anyone, and the latter team claimed to have found a treatment for psychotic illness.
Until the 1970s there was a great debate in psychiatry about the most appropriate terms to be used to describe new drugs. By the end of the 1950s the most widely used term was "neuroleptic", followed by the "main sedative" and then "ataraxic". The first recorded use of the term is derived from the early nineteenth century. In 1953 Frederik F. Yonkman, a chemist at the Swiss-based company Cibapharmaceutical, first used a sedative term to distinguish reserpine from older sedatives. The word neuroleptics was created in 1955 by Delays and Denikers after their discovery (1952) the antipsychotic effect of chlorpromazine. It comes from the Greek: "??????" ( neuron , originally meaning "muscle" but today refers to nerves) and "???????" ( sluggish? , which means "holding"). Thus, the word means holding one's nerve . It is often taken to refer also to common side effects such as general diminished activity, as well as lethargy and impaired motor control. Although these effects are unpleasant and in some cases dangerous, they at one time, along with akathisia, are considered a reliable sign that the drug works. The term "ataraxy" was coined by neurologist Howard Fabing and Alister Cameron classics to illustrate the observed effects of psychic indifference and detachment in patients treated with chlorpromazine. This term is derived from the Greek adjective "?????????" ( ataraktos ), which means "uninterrupted, uninspired, confused, stable, calm". In the use of the terms "tranquilizer" and "ataractic", medical practitioners distinguish between "main sedative" or "main ataractic", which refers to drugs used to treat psychosis, and "minor tranquilizers" or "small atar- vics", referring on drugs used to treat neurosis. Although popular in the 1950s, these terms are rarely used today. They are abandoned for "antipsychotic", which refers to the desired drug effect. Today, "minor tranquilizers" may refer to anxiolytic and/or hypnotic drugs such as benzodiazepines and nonbenzodiazepines, which have some antipsychotic properties and are recommended for concomitant use with antipsychotics, and are useful for drug-induced insomnia or psychosis. They are a potent (and potentially addictive) sedative.
Antipsychotics are broadly divided into two groups, typical antipsychotics or first generation and atypical or second generation antipsychotics. Typical antipsychotics are classified according to their chemical structure while atypical antipsychotics are classified according to their pharmacological properties. These include serotonin-dopamine antagonists (see dopamine antagonists and serotonin antagonists), antipsychotics devoted to multi-acting receptors (MARTA, targeting multiple systems), and partial dopamine agonists, often categorized as atypical.
Society and culture
Terminology
The term tranquilizers is used for older antipsychotic drugs. The term neuroleptics is often used as a synonym for antipsychotics , although - strictly speaking - the two terms are not interchangeable. Antipsychotics is a subgroup of the drug neuroleptic , because the latter has a wider effect.
Antipsychotics are a type of psychoactive or psychotropic drug.
Sales
Antipsychotics was once one of the biggest and most profitable sales of all drugs, generating $ 22 billion in global sales in 2008. In 2003 in the US, an estimated 3.21 million patients received antipsychotics, valued at approximately $ 2.82 billion. Over 2/3 of recipes are for new, more expensive atypicals, each costing an average of $ 164 per year, compared to $ 40 for the older type. In 2008, US sales reached $ 14.6 billion, the best-selling US drug sales by therapeutic class.
Formulation
Antipsychotics are sometimes given as part of a mandatory psychiatric care through an inpatient commitment (hospital) or outpatient commitment. They may be administered orally or, in some cases, by long-acting (depot) injections administered in the dorsgluteal, ventrogluteal or deltoid muscle.
Controversy
Joanna Moncrieff argues that antipsychotic drug treatment is often performed as a control tool rather than treating specific symptoms experienced by patients. Moncreiff further argues that evidence for antipsychotics from studies of cessation of relapse may be defective, as they do not take into account that antipsychotics can make the brain sensitive and provoke psychosis if not continued, which can then be misinterpreted as a relapse of the original condition..
The use of this class of drugs has a history of criticism in the care of housing. Because the drugs used can make patients calmer and more docile, the critics claim that these drugs can be overused. Outside doctors may feel under pressure from hospital care staff. In an official review commissioned by UK government ministers, it was reported that unnecessary use of antipsychotic drugs in the treatment of dementia is widespread and associated with 1800 deaths per year. In the US, the government has initiated legal action against Johnson & amp; Johnson for allegedly paying a bribe to Omnicare to promote antipsychotic risperidone (Risperdal) in a nursing home.
There is also controversy about the role of pharmaceutical companies in marketing and promoting antipsychotics, including allegations of underestimating or covering adverse effects, expanding the number of conditions or promoting the use of labels illegally; influence drug trials (or their publications) to try to show that costly and profitable new atypicals are superior to the less expensive typical of the older ones that are not patents. Following the illegal marketing indictment, the settlement by two major pharmaceutical companies in the US set the record for the biggest criminal penalty ever imposed on the company. One case involved Eli Lilly and the Company's antipsychotic Zyprexa, and the other involved Bextra. In the Bextra case, the government also accused Pfizer of illegally marketing another antipsychotic, Geodon. In addition, Astrazeneca faces many personal injury lawsuits from former Seroquel users (quetiapine), amid federal investigations of its marketing practices. By expanding the conditions indicated, Astrazeneca's Seroquel and Eli Lilly's Zyprexa had become the largest selling antipsychotic in 2008 with global sales of $ 5.5 billion and $ 5.4 billion respectively.
Harvard medical professor Joseph Biederman conducted a study of bipolar disorder in children that led to an increase in the diagnosis. The 2008 Senate inquiry found that Biederman also received $ 1.6 million in talks and consulting fees between 2000 and 2007 - some of them were kept secret to Harvard - from companies including antipsychotic drug makers prescribed for children with bipolar disorder. Johnson & amp; Johnson gave over $ 700,000 to a research center led by Biederman from 2002 to 2005, where research was conducted, in part, on Risperdal, the company's antipsychotic drug. Biederman has replied saying that the money does not affect him and that he does not promote a particular diagnosis or treatment.
Pharmaceutical companies have also been accused of trying to establish mental health agendas through various activities such as financing consumer advocacy groups.
Custom population
It is recommended that people with dementia who exhibit behavioral and psychological symptoms should not be given antipsychotics before attempting other treatments. When taking antipsychotics, this population increases the risk of cerebrovascular effects, parkinsonism or extrapyramidal symptoms, sedation, confusion and other cognitive side effects, weight gain, and increased mortality. Doctors and nurses of people with dementia should try to treat symptoms including agitation, aggression, apathy, anxiety, depression, irritability, and psychosis with alternative treatments whenever antipsychotic use can be changed or reduced. Parents often experience first dementia treated with antipsychotics and this is not the best management strategy.
See also
- List of antipsychotics studied
- Antipsychotic redirects
Note
References
External links
- Are atypical antipsychotics beneficial? - Case for, Australian Prescriber 2005 (note: statement of conflicts of interests of pharmaceutical companies at the end)
- Are atypical antipsychotics beneficial? - Case against, Australian Prescriber 2005
- First Generation Antipsychotics: An Introduction, Psychopharmacology Institute, 2012
- FDA Public Health Advisory - Public Health Advisor for Antipsychotic Medication Used for Behavioral Disorder Treatment in Elderly Patients, fda.gov
- Antipsychotic Drugs - information from the mental health charity Royal College of Psychiatrists
- (in Portuguese) FROTA LH. Fifty Years of Antipsychotic Medicine in Psychiatry. "CinqÃÆ'¼enta Anos de Medicamentos AntipsicÃÆ'³ticos em Psiquiatria." 1st ed; Ebook: Portuguese CD-Rom/On-Line, ISBN 85-903827-1-0,.pdf Files (Adobe Acrobat) 6Mb, Informática, Rio de Janeiro, August 2003, 486pp., Medicina.ufrj.br
- Drug-induced drug supersensitivity is reviewed: recurrent characteristics in treatment-compliant patients, Progress Therapy in Psychopharmacology, 2012
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