ABSTRACT
Conditions Donna L.Londino, Lisa Wiggins, Jennifer Dallas, Edna Stirewalt, and Peter
F.Buckley Medical College of Georgia, Augusta, Georgia, U.S.A.
I.OVERVIEW
A.Introduction
The past 5 years have witnessed a dramatic shift in the pharmacotherapy of adult schizophrenia. Following on the therapeutic success of clozapine in patients with treatment-refractory schizophrenia, there are now several agents available in the United States as first-line choices in the treatment of schizophrenia (Table 1). The evidence for superior efficacy of these agents over typical antipsychotics is substantial and continues to accrue (1). The evidence for a more favorable adverse-effect profile, especially with respect to extrapyramidal side effects (EPS) and tardive dyskinesia (TD), is compelling. Collectively, these data have supported a shift in clinical practice wherein most clinicians in the United States are prescribing atypical antipsychotics as the first-choice agents for new-onset schizophrenia as a maintenance therapy. The preferential role for typical antipsychotics remains in the management of acute agitation in
Table 1 Atypical Antipsychotic Medications Approved for Use in the United States
Generic nameaTrade name Year of FDAb approval
Indication for use beyond psychosisc
Clozapine Clozaril 1990 None
Risperidone Risperdal 1993 None
Olanzapine Zyprexa 1996 Acute mania
Quetiapine Seroquel 1997 None
Ziprasidone Geodon 2001 None
Aripiprazole Abilify 2002 None
psychosis-by the use of acute intramuscular preparations-and in the management of patients who are persistently noncompliant with medication-by the use of long-acting (depot) injections. The coming on-line of both short-acting and depot forms of atypical antipsychotic medication is likely to further diminish the role of typical antipsychotics in clinical practice (2-4). The pace of this shift in treatment patterns and the ultimate equipoise between atypical and typical antipsychotic medications remains to be determined (5,6).
