Neuroleptics clinical pharmacology

J.E. Leysen, Review of neuroleptic receptors specificity and multiplicity of in-vitro binding related to pharmacological activity. In Clinical pharmacology in psychiatry (E. Usdin, S. Dahl, L.F. Gram and O. Lingjaerde, Eds.). MacMillan, London, 1982, pp. 35-62. 

Since the gamut of the clinical pharmacology of tics is broad, it is often difficult to differentiate tics from other hyperkinetic movement disorders. Of 373 cases of Gilles de la Tourette syndrome, 18 had both tics and other abnormal movements 12 were secondary to neuroleptic drug treatment (167). Akathisia was the most common movement disorder. 

To search for novel neuroleptic agents, attention has been given to structural modifications of dibenzoepines such as clozapine (9) [ 17] as a clinically active atypical antipsychotic, and its analogous fluperlapine (10) [18, 19] with a pharmacological resemblance to clozapine. Some 2-piperazinyl-5-phenyl-... 

Atypical antipsychotics The second generation or so-called atypical antipsychotics have chemical, pharmacological, and clinical properties that are different from those of the classical antipsychotics/ neuroleptics. The most commonly used atypicals include clozapine, olanzapine, risperidone, and quetiapine. 

Bamrah IS, Kumar V, Krska 1, et al Interactions between procyclidine and neuroleptic drugs some pharmacological and clinical aspects. Br 1 Psychiatry 1986 149 726-733. 

Richelson, E. (1999) Receptor pharmacology of neuroleptics relation to clinical effects. / Clin Psychiatry 60(Suppl 10) 5-14. 

Despite a number of necessary refinements in later years, the dopamine hypothesis in its simple original version ( neuroleptics act via blockade of postsynaptic dopamine receptors ) is still consistent with many pharmacological and clinical observations, such as ... 

In experimental studies, many clinically effective neuroleptics have been shown to act as 5-HT2A receptor antagonists. Studies on post-mortem brain from schizophrenic patients have shown that the decrease in the number of 5-HT2A receptors in the prefrontal cortex might be related to the disease process. It therefore seems unlikely that the antipsychotic activity of neuroleptics can be explained solely in terms of their action on 5-HT receptors. Furthermore, no correlation exists between the average therapeutic doses of a neuroleptic and its affinity for 5-HT receptors. It does seem possible, however, that several atypical neuroleptics such as amperozide, risperidone and possibly ritanserin do owe at least part of the pharmacological profile to their ability to inhibit 5-HT receptors. 

Partly as a result of the extensive experimental and clinical studies which have been carried out on clozapine in recent years there have been two major approaches to the development of atypical neuroleptics. The first approach has been to develop drugs which broadly simulate the pharmacological profile of clozapine but which lack the adverse haematological effects. Olanzapine is an example of a drug recently... 

Chouinard, G. Jones, B. D. 1980, Neuroleptic-induced supersensitivity psychosis clinical and pharmacologic characteristics, Am.J.Psychiatry, vol. 137, no. 1, pp. 16-21. 

Prozac s pharmacological mechanism for suppressing dopamine is more indirect than that of the neuroleptics. However, the clinical result can be very similar. Prozac can cause akathisia (agitation with hyperactivity), parkinsonism ( Fluoxetine, 1990), and dystonia (muscle spasms) (Meltzer et al., 1979 Reccoppa et al., 1990). 

Berardi D, Amore M, Keck PE Jr, Troia M, Dell Atti M. Clinical and pharmacologic risk factors for neuroleptic malignant syndrome a case-control study. Biol Psychiatry 1998 44(8) 748-54. 

Chouinard G, Jones BD. Neuroleptic-induced supersensitivity psychosis clinical and pharmacologic characteristics. 

Dahl SG (1981) In Usdin E, Dahl SG, Gran LF (eds) Clinical and pharmacology psychiatry neuroleptic antidepressants research (Int Mtg), 2nd edn. Macmillan, London, p 125... 

---