Incisive antipsychotics are those that show very little autonomic activity. They can be administered at very high doses without the appearance of adverse reactions such as sedation or hypotension, which would make it necessary to limit the dose.
Among second-generation antipsychotics, the control of positive symptoms should be highlighted. In the group of new antipsychotics there is a certain homogeneity in this aspect, which suggests that these are differences between specific drugs and not so much between those of one generation and another.
There are antipsychotics with more antipsychotic efficacy, as sometimes at the level of certain specific symptoms intercurrent with positive psychotic symptoms, such as aggressiveness, insomnia, restlessness, impulsivity, affective disturbances and agitation.
action differences
There are also differences in the action of the different antipsychotics regarding the negative and cognitive symptoms present in schizophrenia.
The main characteristic of atypical or second-generation antipsychotics is the limited ability to produce extrapyramidal effects. They also have greater efficacy in both negative and positive symptoms, which have effects in resistant patients.
As more incisive drugs of second generation are risperidone, olanzapine and clozapine.
sedative antipsychotics
Sedative antipsychotics are those that, together with the antipsychotic action, exert relevant autonomic effects, above all, of an anticholinergic, alpha1-adrenergic blocking and H1 antihistamine nature. This favors the appearance of various undesirable side effects, such as sedation, which make it difficult or even prevent fully effective antipsychotic doses from being established. In addition, they can negatively interfere with adequate therapeutic compliance.
There are important differences in the level of sedation induced by the different antipsychotics, but in clinical practice this type of antipsychotic is more useful for controlling some symptoms such as agitation, insomnia or psychotic distress.
Among the new antipsychotics, the partial agonists show a lower tendency to produce sedation in general than in most second-generation antipsychotics, although there are also differences between the latter. The fact of producing less sedation in general makes it better tolerated and facilitates functional recovery with the consequent improvement in the perception of treatment and therapeutic compliance.
Subjective well-being
The new antipsychotics, including cariprazine, have made it possible for the patient to perceive an improvement in subjective well-being, since they cause less flattening, less weight gain and fewer metabolic problems in general.
Amenorrhea has improved in women and decreased sexual desire in men, as a result of its action on prolactin levels.
Although it is not reflected in subjective well-being, the improvement in the lengthening of the QT interval of the electrocardiogram in the case of the new antipsychotics is also an important factor to take into account when choosing long-term treatments.
The improvement in terms of not gaining weight and the maintenance or reduction of prolactin levels that have led to the new antipsychotics, are also decisive factors in terms of treatment abandonment. This leads to a better adherence to treatment and a lower dropout rate.
Side effects
The appearance of secondary effects with the new antipsychotics is less and less relevant. The most frequent in its appearance continues to be akathisia, which can cause discomfort and the need for supervision and adjustment of pharmacological treatment.
Akathisia is usually dose dependent. Thus, with a lower dose or the addition of a benzodiazepine, it is usually corrected, without major complications.
The new antipsychotics represent an improvement over the previous ones, since the side effects are less, especially at the cognitive and metabolic levels.
Doctors Manuel Cassinello Marco, David Esteban García, Carlos Javier Sánchez Miñano, Sonia Gómez Pardiñas, Eva Fontela Vivanco, Mónica González Santos, Paloma Campos Abraham, Cora Fernández Natal and María Martín have collaborated in the preparation of this article. Larregola.