Virtual Medical Centre

Atypical Antipsychotics

• What are atypical antipsychotics?
• What are atypical antipsychotics used for?
• How do atypical antipsychotics work?
• Injectable antipsychotics
• Side effects of atypical antipsychotics
• Precautions

What are atypical antipsychotics?

Atypical antipsychotics are a class of drugs used primarily to treat psychotic disorders. Rationale for use includes relief from symptoms such as hallucinations, delusions or abnormal behaviour/thought, and sedative and tranquillising effects in very disturbed or aggressive patients. Atypical antipsychotics are thought to be better in treating the negative symptoms of schizophrenia although differences may also be due to fewer adverse effects and/or better patient compliance. Members of this class include amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone.

What are atypical antipsychotics used for?

Atypical antipsychotics are used for:

• Treatment of acute and chronic psychoses (e.g. schizophrenia)
• Acute mania (olanzapine, quetiapine, risperidone)
• Organic psychoses (e.g. dementia-associated agitation)
• Severe behavioural disorders in children (risperidone)

How do atypical antipsychotics work?

The exact mechanism of atypical antipsychotics is unknown. They are though to block certain chemical receptors in the brain and hence relieve the symptoms of psychotic disorders. Risperdal Oral (risperidone) works by blocking the receptors of chemical messengers called dopamine and serotonin. Invega (paliperidone) is the substance created when risperidone is ingested into the body and hence works in the same way. Clopine (clozapine), Zyprexa (olanazapine) and Seroquel (quetiapine) block a number of receptor types including dopaminergic, serotonergic, muscarinic, and histaminic and tries to restore the chemical imbalance in the brain. Excessive weight gain and high blood glucose may occur with Clopine (clozapine) and Zyprexa (olanzapine), leading to type 2 diabetes. Solian (amilsulpride) has a variant dose dependent action. At high doses it has an antipsychotic effect; however at low doses it's more effective against the negative symptoms of schizophrenia. The mechanism of action of Abilify (asripiprazole), as well as other drugs having efficacy in schizophrenia, is unknown. Zeldox (ziprasidone) has a complex pharmacology which gives its effectiveness against both positive and negative symptoms of schizophrenia.

Your doctor will decide which treatment is the best for your condition.

Injectable antipsychotics

Antipsychotics can also be administered via injections that release the drug over a period of time. At first, oral medication will also need to be administered as it takes time for the medication to reach steady state levels. The main advantage with administering antipsychotics via a long-acting injectable formula is that it improves compliance with taking the medication and ensures it is taken regularly. Compliance to medication can be poor due to a range of factors such as substance abuse and poor social skills influencing treatment. As a consequence, whilst behavioural therapies would be the most suitable method to promote compliance with medication, this may not be as effective as using injectables.

By ensuring long-term compliance to medication you can prevent relapse by some patients and also reduce symptoms in those suffering from severe forms of the disease. For example, Risperdal Consta is risperidone in an injectable form, administered once a fortnight. Risperidone is used to treat schizophrenia. In summary, injectable antipsychotics ensure patient compliance with medication; this will enable long term treatment of psychosis.

Side effects of atypical antipsychotics

Schizophrenia Medication Tolerability Tool

This tolerability tool is based on a self-rating scale designed by Waddell and Taylor¹ to assess if you are experiencing undesirable side effects from your antipsychotic medication.

Male      Female 

Over the past week have you	Never	Once	A few times	Everyday	Tick this box if distressing
Felt sleepy during the day
Felt drugged or like a zombie
Felt dizzy on standing and/or fainted
Felt that you heart was beating irregularly or unusually fast
Had tense or jerky muscles
Had shaky hands or arms
Had restless legs and/or couldn´t sit still
Been drooling
Noticed your movements or walking being slower than usual
Had, or people have noticed uncontrollable movements of your face and/or body
Had blurry vision
Had a dry mouth
Had difficulty passing urine
Felt like you were going to be sick or have vomited
Wet the bed
Been thirsty and/or passing urine frequently
Had sore/swollen areas around your nipples
Noticed fluid coming from your nipples
Had problems enjoying sex
Had problems getting an erection
In the last 3 months have you noticed	No	Yes			Tick this box if distressing
A change in your periods
Weight gain

The side effects for each type of medication vary but the most common side effects that occur to less than 10% of patients are:

• Weight gain
• Hypotension
• Tachycardia
• Insomnia
• Agitation
• Anxiety
• Headache
• Akathisia
• Hyperprolactinaemia

• Hyperglycaemia
• Dystonia
• Akathisia
• Parkinsonism
• Tardive dyskinesia
• Neuroleptic malignant syndrome

These side effects may not occur, but if you have any concerns, see your doctor about them.

Medication Adherence Rating Scale
(MARS)

Using the MARS tool, you and your patient can determine willingness and ability to take oral medication every day.

		Yes	No
1.	Do you ever forget to take your medication?
2.	Are you careless at times about taking your medicine?
3.	When you feel better, do you sometimes stop taking your medicine?
4.	Sometimes if you feel worse when you take the medicine, do you stop taking it?
5.	I take my medication only when I am sick.
6.	It is unnatural for my mind and body to be controlled by medication.
7.	My thoughts are clearer on medication.
8.	By staying on medication, I can prevent getting sick.
9.	I feel weird, like a ´zombie´, on medication.
10.	Medication makes me feel tired and sluggish.

Results

This individual has scored  out of 10 on the adherence rating scale.

It is likely they are adhering to their schizophrenia medication.

This individual has scored  out of 10 on the adherence rating scale.
They are not adhering to the prescribed medication schedule.

References:

1. Thompson K et al. Schizophrenia Research 2000;42:241-7.
2. Fialko L, et al. Schizophrenia Research 2008;100:53-9.

Precautions

Elderly

The doctor may use a lower starting dose and more gradual dose increases because of greater risk for adverse effects in older people.

Pregnancy

Amisulpride, aripiprazole, olanzapine, quetiapine, risperidone are ADEC category B3; paliperidone and clozapine are ADEC category C. Therapy with an atypical antipsychotic for a person planning to become or is pregnant should be conducted under the supervision of a specialist. Please see your doctor if you have any concerns about it.

For further information, see your doctor.

More information

For more information on schizophrenia and its treatments, and some useful tools, animations and videos, see Schizophrenia.

Related articles:

• Treatment - Conventional Antipsychotics
• Anatomy - Central Nervous System

Reference

1. Atypical antipsychotics [online]. Australian Medicines Handbook. January 2007 [cited 24 October 2007]. Available at URL: http://www.amh.net.au
2. Psychotropic: Atypical antipsychotics [online]. Therapeutic Guidelines. Version 5, 2003 [cited 24 October 2007]. Available at URL: http://www.tg.com.au
3. Pharmaceutical Benefits Schedule [online]. [last cited 24 October 2007] Available at URL: http://www.pbs.gov.au
4. Risperdal [online]. MIMS Australia. 2007 [cited 24 October 2007]. Available at URL: http://www.mims.com.au
5. Clopine [online]. MIMS Australia. 2007 [cited 19 October 2007]. Available at URL: http://www.mims.com.au
6. Zyprexa [online]. MIMS Australia. 2007 [cited 19 October 2007]. Available at URL: http://www.mims.com.au
7. Seroquel [online]. MIMS Australia. 2007 [cited 19 October 2007]. Available at URL: http://www.mims.com.au
8. Solian [online]. MIMS Australia. 2007 [cited 19 October 2007]. Available at URL: http://www.mims.com.au 
9. Abilify [online]. MIMS Australia. 2007 [cited 19 October 2007]. Available at URL: http://www.mims.com.au
10. Zeldox [online]. MIMS Australia. 2007 [cited 19 October 2007]. Available at URL: http://www.mims.com.au

11. Keks NA, Hope J. Long-term management of people with psychotic disorders in the community. Aust Prescr. 2007; 30(2): 44-6.

Drugs used in this treatment:

• Risperdal Oral Solution
(Risperidone)
• Risperdal Oral Quicklet
(Risperidone)
• Risperdal Oral Tablets
(Risperidone)
• Risperdal Consta
(Risperidone Intramuscular Injection)
• Clopine
(Clozapine)
• Seroquel
(Quetiapine fumarate)
• Solian
(Amisulpride)
• Zyprexa
(Olanzapine)
• Abilify
(Aripiprazole)
• Invega
(Paliperidone)

This treatment is used for the following diseases:

• Schizophrenia

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Article Dates:

Created: 25/10/2007

Modified: 3/7/2009