Atypical antipsychotics: characteristics and main uses
Traditionally, the distinction between typical antipsychotics and atypical or second generation antipsychotics, such as quetiapine, olanzapine and risperidone, has been used; nevertheless, at present the usefulness of this dichotomy is very questioned in the scientific community in general.
In this article we will analyze the characteristics and main uses of atypical antipsychotics . We will emphasize in particular the distinction between these drugs and typical neuroleptics.
- Related article: "Types of antipsychotics (or neuroleptics)"
What are atypical antipsychotics?
Atypical antipsychotics are a type of psychotropic drug that is used to treat different mental disorders , in particular schizophrenia and other similar problems, use for which they were designed. Its main effects have to do with the depression of the central nervous system, and therefore with sedation.
The term "atypical" is used to differentiate this class of antipsychotics from the classics, now known as "typical". However, the distinction between the two categories of drugs is blurred and there is debate about its success and its usefulness; to this aspect we will devote the following section.
Antipsychotic medications reduce the symptoms of psychosis and other disorders by the inhibition of dopaminergic activity in the cerebral pathways . Some atypical antipsychotics also interact with the serotonin and noradrenaline receptors, neurotransmitters that are part of the pharmacological class of amines, such as dopamine.
Among the most common side effects and adverse reactions of atypical antipsychotics are malignant neuroleptic syndrome (characterized by muscle rigidity, fever, confusion and cardiac alterations that can cause death), tardive dyskinesia (involuntary movements of the face) or increase of the risk of diabetes.
- Maybe you're interested: "Psychotropic drugs: drugs that act on the brain"
Differences with typical antipsychotics
When modern antipsychotics emerged as clozapine, olanzapine, risperidone, quetiapine or aripiprazole , these drugs were promoted as safer than the neuroleptic drugs that already existed. In particular, there was a lower risk of suffering extrapyramidal symptoms such as parkinsonism, tardive dyskinesia and akathisia.
However, recent research suggests that there are no particularly significant differences between typical antipsychotics and atypical antipsychotics in terms of the severity of side effects, as there are no differences in the degree of efficacy or the mechanism of action. In this sense it has been proposed that it is more useful to distinguish between individual drugs.
In any case, it does seem that Typical antipsychotics cause Parkinsonian symptoms more frequently, while atypical ones are more associated with weight gain and consequently the risk of developing type 2 or non-insulin-dependent diabetes mellitus.
What are these medicines used for?
Atypical antipsychotics are used primarily to treat schizophrenia and bipolar disorder, two of the mental disorders most associated with psychotic symptoms. They are also prescribed occasionally in cases of autism, dementia, generalized anxiety disorder or obsessive-compulsive disorder, but they are not first choice drugs.
1. Schizophrenia
The broad body of research that has been developed over the decades about the effectiveness of neuroleptics reveals that atypical antipsychotics are effective in reducing the positive symptoms of schizophrenia (mainly hallucinations and delusions), but fail in the treatment of negative symptoms such as affective flattening .
In any case, in many cases of schizophrenia and other disorders of the spectrum of psychosis it is necessary to administer this type of drugs to avoid serious symptoms. Even so, the efficacy rate of antipsychotics is not complete, since 20% of patients do not respond adequately and 30-40% do so only partially.
2. Bipolar disorder
In its classic form, bipolar disorder is characterized by alternating between periods in which the mood is very low and others in which it is pathologically elevated; In other words, there are episodes of depression and mania. Atypical antipsychotics are sometimes used to control the symptoms of manic and mixed episodes .
In these cases, medications such as olanzapine and quetiapine are used as coadjuvant therapy for the drugs of choice: mood stabilizers, including lithium and valproic acid or valproate. Atypical antipsychotics are only recommended if the symptoms are severe and the main treatment is insufficient.
- Related article: "Bipolar disorder: 10 features and curiosities you did not know"
3. Dementia
Antipsychotics are prescribed in some cases of dementia if there are significant psychotic symptoms (such as delusions) and especially if there is severe psychomotor agitation; This type of alterations facilitate the appearance of aggressive or interfering behaviors, which can become truly problematic for caregivers and the person.
It is important to mention that it has been detected an increased risk of heart problems, strokes and mortality in general in elderly patients with dementia treated with antipsychotics, particularly the typical ones. Quetiapine, which is included in the atypical group, appears to be safer than other neuroleptics.
4. Autism
Atypical antipsychotics such as risperidone and aripiprazole have been approved in some countries as treatments for certain Characteristic symptoms of autism spectrum disorders : agitation, irritability, aggressiveness, repetitive behaviors, sleeping problems ... In these cases, psychostimulants and antidepressants are also prescribed.
- Related article: "The 4 types of Autism and its characteristics"
