Atypical Antipsychotics

Question 1

What are the indiactions for atypicals?

Answer 1

Same as typicals except they are not used for nausea and vomiting

Urgent treatment of severe psychomotor agitation leading to dangerous or violent behaviour, or to calm such patients to permit assessment.
Schizophrenia, particularly when extrapyramidal side effects have complicated the use of first-generation (typical) antipsychotics, or when negative symptoms are prominent.
Bipolar disorder, particularly in acute episodes of mania or hypomania.

Question 2

What is the difference between typical and atypical antipsychotic drugs?

Answer 2

As compared with first-generation antipsychotics, second-generation agents seem more efficacious in ‘treatment-resistant’ schizophrenia (particularly clozapine) and against negative symptoms, and have a lower risk of extrapyramidal symptoms.

This may be because of a higher affinity for other receptors (particularly 5-HT2A), and a characteristic of ‘looser’ binding to D2 receptors (in the case of clozapine and quetiapine).

Question 3

What symptoms are more common in atypical antipsychotics?

Answer 3

Metabolic disturbance, including weight gain, diabetes mellitus and lipid changes, is a common problem with second-generation antipsychotics.

Question 4

What are the side effects associated with clozapine

Answer 4

Clozapine causes a severe deficiency of neutrophils (agranulocytosis) in about 1% of patients, and rarely causes myocarditis.

Question 5

What are the cautions for use of atypical antipsychotics?

Answer 5

Antipsychotics should be used with caution in patients with ▴cardiovascular disease. Clozapine must not be used in patients with ✗severe heart disease or a history of ✗neutropenia.

Question 6

What are the important interactions for typicals?

Answer 6

Sedation may be more pronounced when used with other sedating drugs. They should not be combined with other ▴dopamine-blocking antiemetics and ▴drugs that prolong the QT interval (e.g. amiodarone, quinine, macrolides, selective serotonin reuptake inhibitors).

Question 7

When are oral antipsychotic medications given?

Answer 7

Usually given at bedtime

Question 8

What are important tests before and during treatment with atypicals?

Answer 8

Blood tests (typically FBC, renal and liver profiles) - particularly important for clozapine

Metabolic: weight, lipid profile and fasting blood glucose at baseline and intermittently during treatment.

Cardiovascular: ECG