Current Developments in the Pharmacologic Treatment of Psychotic Disorders*

The pharmacologic management of schizophrenia has dramatically improved over the past 50 years. While the first-generation, or conventional, antipsychotic medications were found to be helpful in reducing the positive symptoms of the disorder, they had little effect on negative and cognitive symptoms. Additionally, the first-generation agents were associated with the troubling neurologic side effects of extrapyramidal symptoms (EPS) and tardive dyskinesia. The development of second-generation, or atypical antipsychotic drugs, greatly expanded pharmacologic treatment options. These agents were found to effectively treat both positive and negative symptoms of schizophrenia, with a lower incidence of EPS and tardive dyskinesia. However, many of the atypical agents are associated with their own types of distressing side effects, particularly metabolic and endocrine adverse effects. While both conventional and atypical antipsychotic agents block dopamine D2 receptors, atypical agents also block 5-HT2A serotonergic receptors. This dual serotonin/dopamine antagonism is believed to bestow the efficacy and safety profiles observed with these compounds. The antipsychotic agent aripiprazole, newly approved by the US Food and Drug Administration, represents the most recent development in the treatment of schizophrenia. Aripiprazole is a dopamine partial agonist and has demonstrated efficacy in controlling positive, negative, and cognitive symptoms of schizophrenia. When determining which antipsychotic therapy to employ, it is important to consider efficacy not only in positive symptoms but also in negative and cognitive symptoms. Other factors to consider include safety, tolerability, and quality-of-life issues. Healthcare providers must work collaboratively with patients to determine optimal therapy, monitor adverse effects, and increase rates of adherence to treatment. (Adv Stud Nurs. 2004;2(1):9-15)