Pharmacy Aisle Exposé: Antipsychotics for Schizophrenia Management
In the treatment of schizophrenia, two types of antipsychotics - first-generation (FGAs) and second-generation (SGAs) - offer distinct advantages and challenges.
First-generation antipsychotics, developed in the 1950s, primarily block dopamine-2 receptors and are effective in managing positive symptoms such as hallucinations and delusions. However, they come with a higher risk of extrapyramidal symptoms, including muscle spasms, muscle contractions, restlessness, tremor, slow movements, and muscle jerks.
On the other hand, second-generation antipsychotics, developed in the 1980s, have a broader receptor profile, including serotonin antagonism. This broader profile leads to improved outcomes in both positive and negative symptoms, such as social withdrawal and apathy. While SGAs have fewer motor side effects, they are associated with more metabolic risks like weight gain and increased risk of diabetes and lipid abnormalities.
The heterogeneity among SGAs means that their efficacy, side effects, and costs vary widely, so treatment must be individualized. Some SGAs, like amisulpride, clozapine, olanzapine, and risperidone, show better overall symptom improvement than FGAs.
Long-acting injections, whether first- or second-generation, provide a slow release of medication over weeks to months, eliminating the need for daily pills. These injections are often recommended for people who find it challenging to adhere to an oral medication regimen. Second-generation long-acting injectables (LAIs) demonstrate superior adherence, reduced relapse, and significantly lower mortality rates, especially in first-episode schizophrenia patients, compared to first-generation oral antipsychotics.
It is essential to note that while SGAs are generally preferred for long-term treatment due to better tolerability, broader symptom control, and improved survival, FGAs may still be appropriate in certain situations, especially where cost or acute symptom control is prioritized.
Regular monitoring by a physician is necessary when starting medication, including monitoring for symptom control, side effects, and periodic tests for movement associated with the medication, blood sugar levels, cholesterol, and other lipids. Achieving a level of stability that allows for independent living, employment, and meaningful relationships is possible for some people with schizophrenia, especially those who engage in early and consistent treatment. Most individuals with schizophrenia will require lifelong treatment with medication to maintain success and stability.
Dr. Nicole Washington, a board-certified psychiatrist and the Chief Medical Officer of Elocin Psychiatric Services, focuses on the mental health needs of busy professionals and underserved communities. She is the author of the Amazon best-selling book, From Introspection to Action, and hosts the podcast, The C-Suite Confidant. Dr. Washington is a sought-after speaker on various mental health topics and works with organizations to create supportive mental well-being environments for their employees.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996209/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870642/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249876/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680044/ [5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050697/
Scientists have been exploring the potential use of second-generation antipsychotics for the treatment of anthrax-induced psychological symptoms in health-and-wellness research, due to their broad receptor profiles and potential for improved mental-health outcomes. Treatmentseekers might benefit from consulting with health professionals, such as Dr. Nicole Washington, who specialize in mental health and can provide guidance on the best approaches.
