Antipsychotics compared with typicals

No difference in NAA in FL, TL or thalamus in patients on typical or atypical antipsychotics 4 NAA in thalamus of patients on typical antipsychotics compared with controls... 

The overall mean chlorpromazine-equivalents per day (CPZe) dose prescribed differed significantly, with lower dosing in Thailand compared with Malaysia and Australia (p < 0.001) (see Table 11.4). Pairwise comparisons revealed that the mean typical antipsychotic dose was significantly higher in Malaysia compared with Thailand (p < 0.001) and NWMH (p < 0.001). There were significant differences observed (p < 0.001) while comparisons of the mean atypical antipsychotic dose showed that Australia was significantly higher compared with Thailand (p < 0.001) and Malaysia (p < 0.001). 

Given that limitation, the only ways to counteract elevated prolactin are to lower the dose of the antipsychotic or to switch to another antipsychotic that does not elevate prolactin. We prefer switching (especially if the problem has been encountered with an older style typical antipsychotic) to an atypical antipsychotic if side effects of elevated prolactin become problematic. Most atypical antipsychotics, with the exception of risperidone when used in high doses, do not elevate prolactin. There are few compelling reasons to use a typical antipsychotic compared to the newer atypical agents. 

Efficacy in short-term treatment. From studies in adult schizophrenia, it is evident that clozapine treatment has at least the same or superior antipsychotic effect, compared to typical antipsychotics. In some studies, clozapine was superior with regard to symptom reduction in severe and acute schizophrenic patients. As the guidelines do not allow the use of clozapine as a first-choice drug, most patients have been treated before with at least two atypical or typical antipsychotics. Only one controlled trial has assessed the efficacy of clozapine in child and adolescent psychiatry. In this study (Kumra et ah, 1996), clozapine was found to be superior to haloperidol in all measures of psychosis, and showed a striking superiority for both positive and negative symptoms. 

Atypical and typical antipsychotics are to some extent comparable with regard to their clinical efficiency. They differ remarkably, however, with regard to their side effect profiles. Therefore, atypical antipsychotics are currently preferred in the initial treatment of EOS. 

No formal, prospective, long-term efficacy or safety studies of either typical or atypical antipsychotics in children and adolescents with schizophrenia have been conducted (166, 167). However, reports of the long-term treatment of children and adolescents with conduct disorder (181, 182), autism (183), and Tourette s disorder (184) with either haloperidol or thioridazine suggest that the tolerability of these medications in children and adolescents is comparable with that in adults. 

Significant correlation between duration of atypical meds and NAA signal in ACC in patients on atypical antipsychotics typical neuroleptic users showed progressive decrease in NAA levels in ACC 4 NAA in ACC and fewer errors on Wisconsin Card Sort Task in patients treated with atypical meds compared with patients treated with typical antipsychotics 4 NAA/Cr in FL of children with schizophrenia spectrum disorders no medication effects or other metabolite differences found... 

In a study of 7139 antipsychotic drug-naive patients with schizophrenia in Denmark who were followed for 6.6 years (47297 patient-years), 307 developed diabetes (annual incidence rate 0.65%) [26 ]. Significant factors associated with diabetes within 3 months of its development included treatment with low-potency typical antipsychotic drugs (OR=1.5 95% CI=1.1, 2.0), olanzapine (OR=1.4 95% Cl=1.0,1.9), and clozapine (OR=1.7 95% Cl=1.1, 2.5), whereas aripiprazole was associated with a lower risk (OR = 0.51 95% Cl=0.33, 0.80). Patients who stopped taking olanzapine or midpotency typical antipsychotic drugs had no increased risk of diabetes compared with patients who took no antipsychotic drugs at any time. 

More recently, two methodologically advanced studies have been published a comparison between four antipsychotic drugs in a trial of 14 weeks duration (Bilder et al., 2002, see Box 7.1) and a study of 2 years duration comparing an atypical with an older typical antipsychotic drug (Green et al., 2002). 

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