Categorical antipsychotics are those that show very little involuntary activity. It can be taken in very high doses without adverse reactions such as sedation or hypotension, which makes it necessary to reduce the dose.
Among the second-generation antipsychotics, positive symptomatic control should be highlighted. In the group of new antipsychotics, there is a certain heterogeneity in this aspect, which indicates that these are differences between certain drugs and not so much between those of one generation and another.
There are antipsychotics with greater efficacy than antipsychotics, as is sometimes the case at the level of some specific symptoms that overlap with positive psychotic symptoms, such as aggressiveness, restlessness, restlessness, impulsivity, emotional disturbances, and agitation.
There are also differences in the action of different antipsychotics with respect to the negative and cognitive symptoms found in schizophrenia.
The main feature of atypical or second-generation antipsychotics is the limited ability to produce extrapyramidal effects. It also has greater efficacy in both negative and positive symptoms, which has effects on resistant patients.
More stable second-generation drugs include risperidone, olanzapine, and clozapine.
Sedative antipsychotics are those that, together with the antipsychotic effect, exert subjective effects related, above all, to the anticholinergic, alpha-1-adrenergic blocking and H1-antihistamine nature. This results in many unwanted side effects, such as sedation, making it difficult or even completely preventing doses of effective antipsychotics from being established. In addition, it can adversely interfere with appropriate therapeutic compliance.
There are important differences in the level of sedation different antipsychotics elicit, but in clinical practice, this type of antipsychotic is most useful for controlling symptoms such as agitation, restlessness, or psychotic disorder.
Among the newer antipsychotics, partial antipsychotics show a lower tendency to produce sedation in general than most second-generation antipsychotics, although there are also differences between the latter. The fact that sedation is generally reduced makes it more tolerable and facilitates functional recovery with the resulting improvement in treatment perception and treatment compliance.
Newer antipsychotics, including cariprazine, made it possible for the patient to perceive an improvement in subjective well-being, as they cause less flattening, less weight gain, and fewer metabolic problems in general.
Improved menopause in women and decreased libido in men due to its effect on prolactin levels.
Although not reflective of subjective well-being, improvement in EKG QT prolongation in the case of newer antipsychotics is also an important factor to consider when selecting long-term therapies.
The improvement in terms of not gaining weight and maintaining or reducing prolactin levels that led to new antipsychotics, are also critical factors in terms of treatment discontinuation. This results in better adherence to treatment and a lower dropout rate.
The emergence of secondary effects with newer antipsychotics is less significant. The most common manifestation of it is the intolerance of pain, which can cause discomfort and the need for supervision and adjustment of drug therapy.
Acathexia is usually dose dependent. Thus, with a lower dose or the addition of a benzodiazepine, it is usually corrected, without significant complications.
The new antipsychotics are an improvement over the previous one, as the side effects are fewer, especially on cognitive and metabolic levels.
In preparing this article, physicians Manuel Casinello Marco, David Esteban Garcia, Carlos Javier Sánchez-Mignano, Sonia Gomez Bardenillas, Eva Fontilla Vivanco, Monica González Santos, Paloma Campos Abraham, Cora Fernández-Natal, and Maria Martin collaborated.