Medications for Psychotic Symptoms
Antipsychotic medications can be divided into two primary categories: typical and atypical agents (Box 21-6 Antipsychotic Medications).
The typical agents include older antipsychotics that have been available since the late 1950s. The atypical include newer antipsychotics that became available in the U.S. market after 1990.
Even though both groups are effective to alleviate the positive symptoms of schizophrenia, such as delusions and hallucinations, the atypical agents have greater efficacy to manage negative symptoms or deficits in function, such as social withdrawal and blunted affect. Even though typical and atypical agents have different side effect profiles, the general rules in relation to potency may apply as shown in Table 21-6 Potency of Typical Antipsychotics and Side Effects.
Most people respond to one of the typical or atypical agents to a degree at the first psychotic episode. However, some patients may go through a period of trials and errors for months or years to find the best available medication and dosage for them. A trial of any one medication should last for a substantial period, usually 6 to 8 weeks, unless intolerable side effects occur early. Even though the atypical agents have a better side effect profile for long-term treatment, the typical or older agents may be chosen for short-term management of psychosis or long-term management of symptoms that do not respond to the atypical agents.