Incisive antipsychotics are those that show very little autonomic activity. They can be administered in very high doses without the occurrence of side effects such as sedation or hypotension, which would require dose limitation.
Among second-generation antipsychotics, control of positive symptoms should be emphasized. In the group of new antipsychotics there is some homogeneity in this aspect, which suggests that these are differences between specific drugs, and not so much between those of one generation or another.
There are antipsychotics with greater antipsychotic efficacy, as sometimes at the level of certain specific symptoms accompanying positive psychotic symptoms such as aggression, insomnia, anxiety, impulsivity, affective disorders and agitation.
differences in actions
There are also differences in the action of different antipsychotics in terms of the negative and cognitive symptoms present in schizophrenia.
The main feature of atypical or second-generation antipsychotics is the limited ability to induce extrapyramidal effects. They are also more effective in both negative and positive symptoms, which have an effect in resistant patients.
Risperidone, olanzapine and clozapine are more intensive second-generation drugs.
Sedative antipsychotics are those which, together with the antipsychotic action, exhibit corresponding autonomic effects, primarily of an anticholinergic, alpha1-adrenergic blocking and H1 antihistamine nature. This favors the occurrence of various side effects, such as sedation, which make it difficult or even prevent the establishment of fully effective antipsychotic doses. In addition, they may adversely interfere with adequate therapeutic compliance.
There are important differences in the level of sedation caused by different antipsychotics, but in clinical practice this type of antipsychotic is more useful in controlling some symptoms such as agitation, insomnia or psychotic distress.
Among newer antipsychotics, partial agonists show a lower tendency to produce sedation in general than most second-generation antipsychotics, although there are differences between the latter. The fact that it produces less sedation in general makes it better tolerated and facilitates functional recovery with a consequent improvement in treatment perception and therapeutic compliance.
Newer antipsychotics, including cariprazine, allow the patient to feel an improvement in subjective well-being as they cause less flattening, less weight gain, and fewer metabolic problems overall.
Amenorrhea improves in women and reduces sexual desire in men as a result of its effect on prolactin levels.
Although not reflected in subjective well-being, the improvement in QT prolongation of the electrocardiogram in new antipsychotics is also an important factor to consider when choosing long-term treatment.
The improvement in the lack of weight gain and the maintenance or reduction of prolactin levels that led to the new antipsychotics are also crucial factors in discontinuing treatment. This leads to better adherence to treatment and a lower dropout rate.
The occurrence of side effects with new antipsychotics is less and less relevant. The most common in its occurrence is still akathisia, which can cause discomfort and the need for monitoring and correction of pharmacological treatment.
Akathisia usually depends on the dose. Thus, with a lower dose or addition of benzodiazepines, it is usually corrected without major complications.
The new antipsychotics are an improvement over the previous ones, as the side effects are less, especially at the cognitive and metabolic level.
Doctors Manuel Cassinello Marco, David Esteban Garcia, Carlos Javier Sanchez Miniano, Sonia Gomez Pardinyas, Eva Fontella Vivanco, Monica Gonzalez Santos, Paloma Campos Abraham, Cora Fernandez Natal and Maria Martin collaborated in the preparation.