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2001, Número 5

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Salud Mental 2001; 24 (5)


Los antipsicóticos atípicos: Una revisión

García-Anaya M, Apiquian R, Fresán A

Idioma: Español
Referencias bibliográficas: 53
Paginas: 37-43
Archivo PDF: 160.43 Kb.


RESUMEN

En esta revisión se plantea un nuevo concepto para la clasificación de los antipsicóticos atípicos, basada en su mecanismo de acción. El objetivo primordial del desarrollo de un antipsicótico ha sido el de incrementar su eficacia, disminuyendo la presencia de efectos adversos. Los antipsicóticos atípicos han alcanzado este objetivo mediante diferentes mecanismos de acción farmacológica. Recientemente se propuso un nuevo modelo para explicar el mecanismo de acción de los antipsicóticos atípicos. El modelo propone que los antipsicóticos atípicos tienen una constante de disociación rápida del receptor dopaminérgico D2, mediador de la respuesta antipsicótica, condicionando una menor frecuencia de síntomas extrapiramidales y una menor elevación de prolactina, las cuales son las características esenciales de un antipsicótico atípico. El consenso para definir un antipsicótico como atípico implica su eficacia tanto en síntomas positivos como en síntomas negativos de la esquizofrenia, que su eficacia sea superior en l os pacientes con respuesta incompleta a los antipsicóticos típicos o en los pacientes que no responden a otras drogas, y se propone que deben de cumplir por lo menos con dos de las siguientes propiedades: no producir disforia subjetiva, tener poco efecto sedante, pocos efectos autonómicos/cardíacos, leve elevación de los niveles de prolactina, menor disfunción sexual asociada, y aumentar poco el peso corporal. Recientemente, se propuso que los antipsicóticos atípicos deben ser eficaces para manejar los síntomas depresivos y las alteraciones cognoscitivas asociadas con la esquizofrenia. De acuerdo con estos criterios, los siguientes medicamentos se consideran como antipsicóticos atípicos: risperidona, olanzapina, quetiapina, ziprasidona, amisulprida, zotepina, iloperidona, aripiprazol y clozapina. Los antipsicóticos atípicos tienen ventajas sobre los antipsicóticos convencionales, sin embargo, se han relacionado con algunos efectos secundarios, como el síndrome neuroléptico maligno, los problemas cardiovascula res, el aumento de peso, la hiperprolactinemia, la diabetes mellitus y las hiperlipidemias, los cuales se describen en esta revisión.


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