History and Future of Antipsychotic Drugs / 신경정신의학

After the discovery of antipsychotic drugs, the nature of clinical practice entered a period of inexorable transition. The advances of psychopharmacotherapy have interacted in complex ways with clinical practice, and the economics and policy of mental health care systems. The study of the mechanisms of action of these drugs has guided the development of hopefully improved treatment, and stimulated biological research on the pathophysiology of severe mental disorders. Despite the considerable effort to modify and change existing antipsychotic drugs, progress has been modest. This review describes the history of antipsychotic drugs and their impact on clinical practice and the study of psychiatric disorders, and offer prospects for future developments. Although finding new knowledge and methodologies to bring innovative discovery is imperative, as of now, it is important to provide comprehensive care, including the optimal use of existing antipsychotic drugs.

Update on Medications in Schizophrenia

Antipsychotics are a pharmacologically heterogeneous group of compounds, but all act as D2 dopamine receptor antagonists, an action linked to their antipsychotic effect. Today, sixty years on since 1952, we have the FGAs and the SGAs. These medications continue to be useful, and continue to have some troubling adverse effects. As a class, the FGAs are more likely to be associated with EPS but this is primarily true of medications that bind tightly with D2 neuroreceptors, such as haloperidol, and less true of medications that bind weakly, such as chlorpromazine. Anticholinergic effects are especially prominent with weaker-binding FGAs, as well as with the SGA clozapine. As a class, the SGAs, especially clozapine and olanzapine generally tend to cause more problems relating to the metabolic syndrome, such as obesity and type 2 diabetes mellitus. All antipsychotic medications are associated with an increased likelihood of sedation, sexual dysfunction, postural hypotension, prolonged QT interval and sudden death. Primary care physicians need to be familiar with the individual adverse effect profiles of these medications.