Antipsychotic Medications

Introduction to Antipsychotics

The American Academy of Child and Adolescent Psychiatry recommends that atypical antipsychotics are considered first-line treatment for schizophrenia due to their improved side effect profile and efficacy for both positive and negative symptoms 1
Typical antipsychotics are effective for positive symptoms of schizophrenia but have limited efficacy for negative symptoms 1

Extrapyramidal symptoms (EPS) are a common side effect of typical antipsychotics, including acute dystonia, akathisia, and parkinsonism 2
Tardive dyskinesia is a potential side effect of typical antipsychotics, characterized by involuntary movements, particularly affecting the face and mouth 2
Atypical antipsychotics have a lower risk of EPS and tardive dyskinesia compared to typical antipsychotics 4
Cardiovascular effects, such as orthostatic hypotension and QT prolongation, can occur with atypical antipsychotics 4

High-potency typical antipsychotics, such as haloperidol and droperidol, are less sedating but more likely to cause EPS 3
Low-potency typical antipsychotics, such as chlorpromazine and thioridazine, are more sedating but less likely to cause EPS 3
Aripiprazole is a partial dopamine agonist with a lower metabolic risk compared to other atypical antipsychotics 3
Clozapine requires weekly blood monitoring for the first 6 months, then biweekly, due to the risk of agranulocytosis 5
Risperidone has a higher risk of EPS among atypical antipsychotics, especially at higher doses 4

For acute agitation in emergency settings, benzodiazepines or conventional antipsychotics are effective as monotherapy 8
For patients with known psychiatric illness, atypical antipsychotics are preferred for both acute management and maintenance 8
Combination therapy with oral benzodiazepine and oral antipsychotic may be used for cooperative but agitated patients 8