Atypical conventional

Emsely, R. Booysen, F. (2004) Cost effectiveness of an atypical conventional antipsychotic in South Africa, South African Journal of Psychiatry, 10 (3), 58-66. 

Antipsychotics (conventional agents have nonspecific dopamine receptor antagonsim atypical agents also have serotonin antagonist activity), ecopipam, GBR-12909 and other partial dopamine agonists (may be functional antagonists)... 

Health-care decision-makers may be required not only to make economic choices between conventional and atypical drugs, but also between individual atypical agents. There are few direct comparisons of atypical drugs. This is probably a result of the marketing aims of pharmaceutical manufacturers each has sought to establish the cost-effectiveness of their product compared with conventional... 

Changes in perceived physical and mental health status of a schizophrenia patient population following initiation of a conventional or an atypical antipsychotic medication. Poster presented at the American Psychiatric Association Annual Meeting, Toronto, June 1998. 

Farde, L, Wiesel, FA, Nordstrom, AL and Sedvall, G (1989) Dj and D2 dopamine receptor occupancy during treatment with conventional and atypical neuroleptics. Psychopharmacology 99 (Suppl) 528-531. 

Conventional antipsychotic drugs such as chlorpromazine and haloperidol have long been used in the treatment of acute mania. More recently, atypical antipsychotic drugs including aripiprazole, olanzapine, quetiapine, risperidone, and ziprasi-done have been approved for the treatment of bipolar mania or mixed mood episodes as monotherapy or in combination with mood-stabilizing drugs.25 Aripiprazole and olanzapine are also approved for maintenance therapy. The combination of olanzapine and fluoxetine is approved for treatment of bipolar depression. Quetiapine is approved for treatment of... 

Figure 6 Schematic diagrams of atypical high-pressure SF-CL systems based on special mixing modes (a) system based on conventional propelling and stopping syringe and (b) system based on liquid chromatographic (LC) pumps and stopping the flow before the mixer (M). V, six-ports valve. (Adapted from Refs. 33 and 34.)...

The reactions reported by Casey (14) for a third carbene complex, (CO)5W=C(CH3)Ph, are not pertinent to the present topic because extremely rapid /8-H transfer to tungsten at -78°C initiates a sequence of reactions unique to this particular complex. This type of H transfer is atypical of conventional metatheses. 

Atypical Hp phenotypes have, though very rarely, been reported (B8, G2, G3, G5, G6, S8). It must be questioned whether all of them are inherited variants (B2). A modified type of 2-1 (2-1 M) has repeatedly been observed. In this phenotype the concentration of the haptoglobins of low-molecular weight is higher and the concentration of haptoglobins of high-molecular weight is lower than in the conventional 2-1 type. Hp 2-1 M is relatively common in Africa (B8, G5), but not in Europe (H2). 

Delusions/Psychosis. Demented patients who are acutely psychotic and agitated should be treated in much the same manner as demented patients with delirium. Low doses of a high potency conventional antipsychotic like haloperidol were once preferred. This was mainly because it can be given both orally and by injection. In recent years, the atypical antipsychotic ziprasidone, which is now also available in oral and injectable forms, has superseded haloperidol as the preferred agent when treating the acutely psychotic and agitated patient with dementia. As previously noted, ziprasidone affords the same tranquilizing benefit as haloperidol, it can now be administered via injection when necessary, and it avoids the problematic extrapyramidal symptoms of haloperidol to which patients with dementia are often keenly sensitive. 

The side effects of conventional antipsychotics are of even greater concern when treating chronic psychosis in a patient with dementia. With sustained administration of a typical antipsychotic, these patients will be highly vulnerable to the extrapyramidal effects of the medication, which can increase the risk for falls. Thus, atypical antipsychotics have also been rapidly accepted as first-line agents when treating... 

There are, of course, risks with long-term use of conventional antipsychotics. The most concerning is an irreversible movement disorder known as tardive dyskinesia. Nevertheless, some particularly fragile patients with BPD may require long-term antipsychotic treatment. If so, atypical antipsychotics are recommended. 

Schbnwasser DC, Marais RM, Marshall C], Parker P) (1998) Activation of the mitogen-activated protein kinase/extracellular signal-regulated kinase pathway by conventional, novel, and atypical protein kinase C isotypes. Mol Cell Biol 18 90-798... 

Figure 13.1 hERG compound data obtained from PubChem BioAssay AID 376. Upper line Conventional hERG blockers. Lower line Atypical hERG blockers which do not contain the conventional pharmacophore of a basic nitrogen, decorated by a set of lipophilic rings, (also see Chapter 16). 

Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005 353(22) 2335-41. 

The conventional antipsychotics have little effect on the negative psychotic symptoms such as autism, stupor and emotional withdrawal. The so-called atypical antipsychotics, or second-generation antipsychotics, like the heterocyclic compound risperidone, the benzamide sulpiride and several diben-zepines of which clozapine is the best known, have a broader spectrum which means that they also have an effect on the negative psychotic symptoms. Most share a common attribute of working on serotonin receptors as well as dopamine receptors. They have a low risk of extrapyramidal side effects. 

The other group within this class of dibenzazepines are formed by agents which are related to clozapine. Clozapine is an atypical antipsychotic which is used for the treatment of schizophrenia. It is primarily indicated for schizophrenic patients with predominantly negative symptoms. Its indication can be extended to those patients that have shown to be refractory to the conventional neuroleptics. It can also be substituted for other antipsychotics in... 

AAp, atypical antipsychotic CAp, conventional antipsychiotic, ECT, electtoconvulsive thetapy. 

In the Expert Consensus survey (Rush and Frances, 2000), the respondents identified newer atypical anti-psychotics and anticonvulsants or mood stabilizers as first-line treatments for self-injury. Antidepressants, naltrexone, and conventional antipsychotics were given ratings at least midway or higher on the scale provided. 

Atypical neuroleptics. Because of the limited effectiveness and safety of conventional neuroleptics in TS, clinicians have turned to a new generation of neuroleptics that have been introduced for the treatment of schizophrenia. Risperidone, a member of a class of antipsychotics that blocks both DA and serotonin receptors, has been established as superior to placebo and equal, or superior, to haloperidol in the treatment of schizophrenia (Chouinard et al. 1993 Marder and Meibach 1994]. Risperidone has a more favorable side-effect profile than that of conventional neuroleptics and may have less potential for producing tardive dyskinesia. Compared with haloperidol, fewer extrapyramidal side effects are observed with risperidone in doses of 6 mg/ day or less. As encouraging reports appear in the literature (Lombroso et al. 1995 Stamenkovic et al. 1994 van der Linden et al. 1994], risperidone is currently being widely used by clinicians to treat tic disorders. 

EPS include acute dystonic reactions, parkinsonian syndrome, akathisia, tardive dyskinesia, and neuroleptic mahgnant syndrome. Although high-potency conventional antipsychotics are more hkely than low-potency conventional antipsychotics to cause EPS, all first-generation antipsychotic drugs are equally hkely to cause tardive dyskinesia. The atypical antipsychotics cause suhstantially fewer EPS, which is one reason that they are recommended as first-line agents. 

Most conventional antipsychotics are associated with a dose-depen-dent risk of a lowered seizure threshold, although the incidence of seizures with most of these drugs is quite small (Devinsky et al. 1991). Of all the conventional antipsychotics, molindone and fluphenazine have been shown most consistently to have the lowest potential for this side effect (ltd and Soldatos 1980 Ohver et al. 1982). The atypical antipsychotic clozapine is associated with a dose-dependent risk of seizure. 

Treatment with atypical antipsychotics recently has been associated with an almost twofold increased mortality rate when used in elderly patients with dementia. Although these medications are not approved for treatment of dementia-related psychosis, such use is common in clinical practice (Herrmann and Lanctot 2005). At present, this appears to be a risk for the entire class. The risk associated with atypical antipsychotics is not statistically different from the risk associated with treatment with conventional antipsychotics (Gill et al. 2005). 

Atypical antipsychotics cause fewer EPS than do conventional antipsychotics. Clozapine and quetiapine are the least likely to cause EPS and are therefore recommended for treatment of psychosis in patients with Parkinson s disease. With the notable exception of risperidone, atypical antipsychotics cause substantially less hyperprolactinemia than do conventional antipsychotics. Weight gain is a side effect of all atypical antipsychotics except ziprasidone and aripiprazole. Concerns about cardiac conduction delay with ziprasidone therapy exist and warrant consideration in patients who have... 

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