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Schizophrenia Treatment - Antipsychotic Medications

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA

Antipsychotics are divided into two categories. The first-generation are known as "typical" drugs. The second-generation are known as "atypical" drugs. Typical antipsychotics were the first family of drugs discovered to treat psychotic symptoms. Some examples of "typical" antipsychotic medications are: chlorpromazine, fluphenazine, haloperidol, molindone, thiothixene, thoridazine, trifluoperazine, and loxapine.

pile of pills Atypical antipsychotic drugs were developed later and named to distinguish them from the earlier drugs. Some examples of "atypical" antipsychotic medications include: clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole.

The distinction in these category names also reflects differences in how they were thought to work. Typical medications were originally thought to work primarily by affecting dopamine in the brain. Atypical drugs were thought to work through other brain chemical systems. Recent research, however, suggests that all these drugs mainly affect dopamine systems.

Atypical medications can offer some advantages over typical medications. They seem to:

  • produce greater negative symptom relief
  • affect thinking and comprehension less
  • offer better relapse prevention and ability to function in daily life
  • have fewer extrapyramidal symptoms (EPS) and cause less tardive dyskinesia (TD) (see discussions below)

These are significant advantages and suggest that where tolerated and appropriate, atypical medication therapy may result in a better quality of life for those living with schizophrenia. Antipsychotic medications of all varieties come in tablet/pill and liquid forms. They are usually taken once a day. Some are also available in long-lasting forms that can be injected once or twice a month. Injectable types may be necessary in situations where people will not voluntarily take their medications and must be forced to do so for relief of psychotic symptoms. Medications are generally only forced when necessary for safety reasons.

Doctors will also give additional medications for to address other symptoms besides the hallucinations/delusions. For example, antidepressants and mood stabilizers may be used where mood symptoms are a problem and anti-anxiety medications may be given on an as needed basis for when anxiety is an issue.

Antipsychotic Medication Side Effects

Side effects of antipsychotic medications can be serious. One form of side effect is extrapyramidal symptoms (EPS). This can leave patients with body stiffness, tremor, slowed movement, loss of capability for facial expression, and restlessness. These symptoms result from the blockage of dopamine receptors in the brain. They are very similar to Parkinson's disease, which also results from a dopamine deficiency. In general, typical medications produce more EPS than do atypicals. This is a primary reason why atypicals have become more popular in the treatment of schizophrenia.

Another potential side effect of typical antipsychotic use is Tardive Dyskinesia (TD), This is a condition characterized by involuntary body movements, most often happening with the mouth and facial twitching. Symptoms may range from mild to severe, and can be permanent once they have started. More commonly, they can be partly or completely reversed though.

Atypical medications also have their side effects as well. These drugs cause weight gain, high blood sugar (hyperglycemia) and high cholesterol(dyslipidemia). Other side effects may include a decrease in sexual performance abilities and/or interest, menstrual problems, and sensitivity to sunburn or skin rashes.

Patients or family members should let doctors know when side effects happen. Doctors can sometimes prescribe different medications, change dosages or schedules, or give additional medications to control and minimize side effects.