History and Development of Antipsychotic Medications

Numerous other drugs followed (see table 10) and these typical antipsychotics became one of the five most common classifications of medication for treating mental health disorders. 

According to Carpenter, Conley, and Buchanan (1998), stimulants such as cocaine and amphetamines activate the dopaminergic system in the brain, which explains why the abuse of stimulants can induce a paranoid psychosis that mimics the positive symptoms representative of schizophrenia. In turn, if a person who is diagnosed with schizophrenia is given stimulants of this type, the psychosis may be exacerbated. It follows, therefore, that the typical antipsychotic medications act by blocking the dopamine receptors. 

In addition, some researchers believe that involvement of the neurochemical dopamine alone is not comprehensive enough to explain the complex changes that occur in schizophrenia. Although dopamine does seem to be directly involved in the positive symptoms of the condition, it appears to have little effect on the negative symptoms of the disease (Carpenter, Conley, Buchanan, 1998). Other neurotransmitters such as serotonin also need to be taken into account when dealing with schizophrenia (Karper Krystal, 1996). 

At present there are several medications that have been approved that involve the neurochemical serotonin. The first two medications are clozapine and risperidone and the two newer medications are Seroquel and Zyprexa. To date, these medications have been termed the atypical antipsychotic medications, because they are effective in reducing symptoms of schizophrenia and are less likely to cause extrapyramidal side effects than the other antipsychotic medications (Karper Krystal, 1996). 

The traditional or typical antipsychotics are dopamine inhibitors that block other neurotransmitters such as acetylcholine, histamine, and norepinephrine. Extrapyramidal symptoms (EPS) are a common side effect with these medications, and the social worker must be able to recognize them. Dystonia is one of the movement problems that may occur, and acute dystonic reactions may present as grimacing, difficulty with speech or swallowing, oculogyric crisis (upward rotation of the eyeballs), muscle spasms of the neck and throat, and extensor rigidity of the back muscles (Carpenter, Conley, Buchanan, 1998). Very often these parkinsonian reactions will occur within the first few days of treatment. It is not uncommon for the client to approach the social worker complaining of a thick or stiff tongue that impairs the ability to speak. 

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