Antipsychotic Drugs

Formerly known as "major tranquilizers" or "neuroleptics," the antipsychotic drugs have revolutionized the treatment of schizophrenia and other psychoses. The underlying cause of psychosis is not known, but it is thought to be related to the neurotransmitter dopamine. Most of the antipsychotics block the dopamine receptors in the brain. The older antipsychotic drugs include thorazine, thioridazine, perphenazine, trifluoperazine, fluphena-zine, thiothixene, and haloperidol. These older drugs treat the so-called positive symptoms of schizophrenia—hallucinations and delusions—but they have little effect on the "negative" symptoms—withdrawal, poor interpersonal relationships, and slowing of the body's movement. They also have multiple serious side effects including severe muscle spasm, tremor, rigidity, shuffling gait, stupor, fever, difficulty speaking, blood pressure changes, restlessness, and involuntary movements of the face, trunk, arms, and legs. Some of these are treatable using other drugs, but some are neither treatable nor reversible.

In an effort to overcome these problems, newer antipsychotics have been developed. The first of these was clozapine, which was successful in treating about one-third of the patients who did not respond to other antipsychotic drugs. While it had fewer of the serious side effects listed above, a small per centage of patients experience a severe drop in the white blood cells, which puts them at risk for serious infection. For this reason, patients on clozapine must be followed with frequent blood counts. Other newer antipsychotics include risperidone, olanzapine, and quetiapine. In addition to fewer of the serious side effects, the newer antipsychotics seem to have some effect on the negative symptoms.

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