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Perspective - The Cognitive Neuroscience Journal (2024) Volume 7, Issue 2
Antipsychotics mechanisms, clinical applications, and emerging trends
Katharina Strube*
Department of Medicine, Aalborg University, Denmark.
- *Corresponding Author:
- Katharina Strube
Department of Medicine,
Aalborg University,
Denmark.
E-mail:Strube@katharina.dk
Received: 25-Mar-2024, Manuscript No. aacnj-24-136342; Editor assigned: 28-Mar-2024, PreQC No. aacnj-24-136341(PQ); Reviewed: 11-Apr-2024, QC No. aacnj-24-136342; Revised: 16-Apr-2024, Manuscript No. aacnj-24-136342(R); Published: 23-Apr-2024, DOI:10.35841/aacnj-7.2.205.
Citation: Katharina Strube, Department of Medicine, Aalborg University, Denmark, E-mail: Strube@katharina.dk.
Introduction
Antipsychotic medications, also known as neuroleptics, play a pivotal role in the treatment of various psychiatric disorders, particularly schizophrenia and bipolar disorder. These medications are designed to alleviate symptoms of psychosis, including hallucinations, delusions, and disorganized thinking. In this comprehensive article, we explore the mechanisms of action, clinical applications, side effects, and emerging trends in the use of antipsychotic medications [1].
Antipsychotic medications exert their therapeutic effects by modulating neurotransmitter systems in the brain, particularly dopamine and serotonin. There are two main classes of antipsychotics: typical (first-generation) antipsychotics and atypical (second-generation) antipsychotics.
Typical antipsychotics, such as chlorpromazine and haloperidol, primarily block dopamine D2 receptors in the mesolimbic pathway of the brain. By antagonizing dopamine transmission in this pathway, typical antipsychotics reduce the positive symptoms of schizophrenia, such as hallucinations and delusions. However, they are also associated with a high risk of extrapyramidal side effects, such as dystonia, akathisia, and tardive dyskinesia [2].
Atypical antipsychotics, such as risperidone, olanzapine, and quetiapine, have a broader pharmacological profile compared to typical antipsychotics. In addition to dopamine receptor blockade, atypical antipsychotics also antagonize serotonin receptors, particularly the 5-HT2A receptor. This dual mechanism of action is thought to improve the efficacy of atypical antipsychotics in treating both positive and negative symptoms of schizophrenia, while reducing the risk of extrapyramidal side effects. However, atypical antipsychotics are associated with metabolic side effects, such as weight gain, dyslipidaemia, and insulin resistance [3].
Schizophrenia is a chronic and severe mental disorder characterized by psychotic symptoms, cognitive deficits, and impaired social functioning. Antipsychotic medications are the cornerstone of treatment for schizophrenia, helping to alleviate positive symptoms (e.g., hallucinations, delusions) and improve overall functioning. Long-term maintenance treatment with antipsychotics is often necessary to prevent relapse and maintain stability [4].
Bipolar disorder is a mood disorder characterized by recurrent episodes of mania (elevated mood, increased energy) and depression (low mood, loss of interest). Antipsychotic medications, particularly atypical antipsychotics, are used as adjunctive treatments in bipolar disorder to manage acute manic or mixed episodes and prevent recurrence of mood episodes [5].
In some cases of treatment-resistant depression or severe depression with psychotic features, antipsychotic medications may be used adjunctively with antidepressants to augment the antidepressant effects and alleviate psychotic symptoms. Quetiapine and aripiprazole are among the atypical antipsychotics commonly used in this context. Antipsychotic medications may also be used in the treatment of other psychotic disorders, such as schizoaffective disorder, psychotic depression, and drug-induced psychosis.
Typical antipsychotics are associated with a higher risk of EPS, including acute dystonia (muscle spasms), akathisia (restlessness), Parkinsonism (tremor, rigidity), and tardive dyskinesia (involuntary movements). Atypical antipsychotics have a lower propensity for EPS but may still cause Parkinsonism and akathisia, particularly at higher doses [6].
Atypical antipsychotics are associated with metabolic side effects, including weight gain, dyslipidaemia, hyperglycaemia, and an increased risk of diabetes mellitus. These metabolic side effects can contribute to cardiovascular disease and other medical comorbidities, emphasizing the importance of monitoring metabolic parameters and promoting healthy lifestyle behaviours in patients taking antipsychotic medications [7].
In addition to EPS, antipsychotic medications may cause other neurological side effects, such as sedation, cognitive impairment, and neuroleptic malignant syndrome (NMS), a rare but potentially life-threatening condition characterized by fever, altered mental status, and autonomic instability [8].
Some antipsychotic medications, particularly risperidone and paliperidone, can increase serum prolactin levels, leading to side effects such as galactorrhoea, gynecomastia, menstrual irregularities, and sexual dysfunction. Monitoring of prolactin levels and assessment of related symptoms are recommended in patients taking these medications [9].
The field of psychopharmacology is continually evolving, with ongoing research focused on developing novel antipsychotic medications with improved efficacy, tolerability, and safety profiles. Some emerging trends and future directions in the use of antipsychotics. Personalized Medicine: Advances in genetics and pharmacogenomics may enable the identification of genetic markers associated with treatment response and side effects to guide personalized treatment decisions in psychiatric disorders, including schizophrenia and bipolar disorder [10].
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