Mental health articles

Antipsychotic medication, as the name implies, is used to treat symptoms of psychosis. Antipsychotics were also known as neuroleptics and in times past were referred to, somewhat misleadingly, as major tranquilisers. Chlorpromazine, the fi rst of the antipsychotics, was introduced in 1952 and was the fi rst effective treatment for psychosis. The impact of this cannot be underestimated and it led Holmes to observe that: ‘Almost overnight, psychiatric wards were transformed from “snake pits” where patients lived in strait jackets and were largely out of control to places of relative calm and order.’ Holmes  Research and development led to a group of related drugs, the phenothiazines, and other drugs which acted in similar ways but were chemically distinct, such as the butyrephenones (e.g. haloperidol and droperidol) and thioxanthenes (e.g. zuclopenthixol).

Collectively these may be considered the typical or fi rst generation antipsychotics. Subsequently a second generation of antipsychotics was developed, which became known as the atypical antipsychotics, as they have a notably different side-effect profi le from the typical group. The fi rst to be launched was clozapine, followed by others such as risperidone, olanzapine and quetiapine. Recently, with the introduction of aripiprazole, it may be said that a third generation of antipsychotics has emerged; these drugs have a different mechanism of action to both the typical and atypical drugs. Although there are many large-scale trials of antipsychotics which allow us to make broad statements about their effects, individual responses remain idiosyncratic. Often, fi nding the drug that best suits a person is a matter of trial and error. However, broad guidance for treatment is contained in Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care.

Treatment adherence with antipsychotics is a major clinical issue impacting on areas such as safety, relapse and long-term prognosis. Kikkert et al. explored factors that infl uenced treatment adherence with antipsychotics in a European, multi-centre concept mapping study. Results showed that the single most important factor for service users was whether or not the treatment was effective. The second most important factor was side-effect self-management. Understanding the pharmacology of antipsychotics enables clinicians to assist clients in addressing these factors.

Tags: antipsychotics, medication