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2001, Number 5

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Salud Mental 2001; 24 (5)

Los antipsicóticos atípicos: Una revisión

García-Anaya M, Apiquian R, Fresán A

Language: Spanish
References: 53
Page: 37-43
PDF size: 160.43 Kb.


ABSTRACT

This review elucidates a new concept for the classification of atypical antipsychotics based on their mechanism of action. The primary aim in the development of an antipsychotic is that of increasing its efficacy and decreasing the frequency of adverse effects. Atypical antipsychotics have reached this goal by different pharmacological action mechanisms. Recently, a new model was suggested for explaining the action mechanism of atypical antipsychotics. This model suggests that atypical antipsychotics have a constant of faster dissociation from the dopaminergic receptor D2, which modulates antipsychotic response, conditioning a lower frequency of extrapyramidal symptoms and a lower prolactin elevation, which are the essential features of an atypical antipsychotic. To define an antipsychotic as atypical it should prove its efficacy in the positive and the negative symptoms of schizophrenia; it should be outstandingly efficient in patients with partial response or lack of it to typical antipsychotics, and it must have at least two of the following properties: no association with subjective dysphoria, low sedative effect, few cardiac/autonomic side effects, mild elevation of prolactin levels, lower associated sexual dysfunction and minimal weight gain. It has been recently proposed that atypical antipsychotics must show their efficacy in the treatment of depressive symptoms and cognitive deficits associated to schizophrenia. According to these criteria the following drugs are considered as atypical antipsychotics: risperidone, olanzapine, quetiapine, ziprasidone, amisulpride, zotepine, iloperidone, aripiprazole and clozapine. These properties offer advantages over conventional antipsychotics, nevertheless, atypical antipsychotics have been associated with some adverse effects such as neuroleptic malignant syndrome, cardiovascular effects, weight gain, prolactin elevation, diabetes mellitus and hyperlipidemia, which are summarized in this review.


REFERENCES

  1. ALLISON DB, MENTORE JL, HEO M, CHANDLER LP,CAPPELLERI JC, INFANTE MC, WEIDEN PJ: Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry, 156(11):1686-1696, 1999.

  2. AMERICAN PSYCHIATRIC ASSOCIATION: Practice Guideline for the treatment of patients with schizophrenia. Am J Psychiatry, 154, abril, 1997.

  3. APIQUIAN R, FRESAN A, ULLOA RE: Diagnóstico y tratamiento de los pacientes con primer episodio psicótico. Sa- lud Mental, 22 (número especial):79-87,1999.

  4. BUSTILLO JR, BUCHANAN RW, IRISH D: Differential affect of clozapine on weight: a controlled study. Am J Psychiatry, 153:817-819, 1996.

  5. CADOR M, ROBBINS JW, EVERITT BJ, SIMON H, LE MOAL M, STINUS L: Limbic-striatal interactions in rewardrelated processes: modulation by the dopaminergic system.En: Willner P, Sheel-Krüger J (eds). The Mesolimbic DopamineSystem: From Motivation to Action. John Wiley& Sons, 225-250,sa, 1991.

  6. COLLABORATIVE WORKING GROUP ON CLINICAL TRIAL EVALUATIONS: Adverse effects of the atypical antipsychotics. J Clin Psychiatry, 59(Supl 12):17-22, 1998.

  7. DASKALALIS Z, CHRISTENSEN B, ZIPURSKY R, ZHANG-WONG J, BEISER M: Relationship between D2 occupancy and prolactin levels in first episode psychosis. BiolPsychiatry, 43:113S, 1998.

  8. DICKSON RA, GLAZER WM: Neuroleptic-induced hyperprolactinemia. Schizophr Res, 35(supl):75-86, 1999.

  9. FARDE L, NORDSTROM AL, WIESEL FA, PAULI S, HALLDIN C, SEDVALL G: Positron emission tomographic analysis of central D1 and D2 dopamine receptor occupancy in patients treated with classical neuroleptics and clozapine:relation to extrapyramidal side effects. Arch Gen Psychiatry, 49:538-544, 1992.

  10. FOREYT J, GOODRICK K: The ultimate triumph of obesity. Lancet, 346:34-35, 1995.

  11. FREEMAN HL: Amisulpride compared with standard neuroleptics in acute exacerbations of schizophrenia: three efficacy studies. Int Clin Psychopharmacol, 12:S11-S17, 1997.

  12. GEDDES J, FREEMANTLE N, HARRISON P, BEBBINGTON P, FOR THE NATIONAL SCHIZOPHRENIA GUIDELINE DEVELOPMENT GROUP: Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ,321:1371-1376, 2000.

  13. GERLACH J: New antipsychotics: classification, efficacy and adverse effects. Schizophr Bull, 17:289-309, 1991.

  14. GHAELIP, DUFRESNE RL: Serum triglyceride levels in patients treated with clozapine. Am J Health Syst Pharm, 53:2079-2081, 1996.

  15. HASAN S, BUCKLEY P: Novel antipsychotics and the neuroleptic malignant syndrome: a review and critique. Am J Psychiatr, 155:1113-1116, 1998.

  16. HENDERSON DC, CAGLIERO E, GRAY, COLIN, NASRALLAH, RIMA A y cols.: Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: a five-year naturalistic study. Am J Psychiatry, 157(6):975-981, 2000.

  17. HUTTON J: The economics of treating obesity. Pharmacoeconomics, 5:66-72, 1994.

  18. KAMRAM A, DORAISWAMY PM, JANE JL HAMMETT EB, DUNN L: Severe hyperglycemia associated with high doses of clozapine. Am J Psychiatry, 151:1395, 1994.

  19. KAPUR S, ZIPURSKY R, REMINGTON G, JONES C, MCKAY G, HOULE S: PET evidence that loxapien is an equipotent blocker of 5-HT2 and D2 receptors: implications for the treatment of schizophrenia. Am J Psychiatry, 154:1525- 1529, 1997.

  20. KAPUR S, ZIPURSKY RB, REMINGTON G, JONES C, DASILVA J, WILSON AA, HOULE S: 5-HT2 and D2 receptor occupancy of clozapine, risperidone and olanzapine in schizophrenia. Am J Psychiatry, 155:921-928, 1998.

  21. KAPUR S: A new framework for investigating antipsychotic action in humans: lessons form PET imaging. Mol Psychiatry, 3:135-140, 1998.

  22. KAPUR S, ZIPURSKY RB, REMINGTON G: Clinical and theoretical implications of 5-HT2 and D2 receptor occupancy of clozpine, risperidone and olanzapine in schizophrenia. Am J Psychiatry, 156:286-293, 1999.

  23. KAPUR S, ZIPURSKY R, JONES C, SHAMMI CS, REMINGTON G, SEEMAN P: A positron emission tomography study of quetiapine in schizophrenia: a preliminary finding of an antipsychotic effect with only transiently high dopamine D2 receptor occupancy. Arch Gen Psychiatry, 57:553-559, 2000.

  24. KAPUR S, ZIPURSKY R, JONES C, REMINGTON G, HOULE S: Relationship between dopamine D2 occupancy, clinical response, and side effects: a double-blind PET study of first-episode schizophrenia. Am J Psychiatry, 157:514-520, 2000.

  25. KAPUR S, SEEMAN PHILLIP: Does fast dissociation from the dopamine D2 receptor explain the action of atypical antipsychotics?: a new hypothesis. Am J Psychiatry, 158(3): 360- 369, 2001.

  26. LAWLER CP, PRIOLEAU C, LEWIS MM, MAK C, JIANG D, SCHETZ JA, GONZALEZ AM, SIBLEY DR, MAILMAN RB: Interactions of the novel antipsychotic aripiprazole (OPC-14597) with dopamine and serotonin receptor subtypes. Neuropsychopharmacology, 20(6):612-27, 1999.

  27. MELTZER HY, MATSUBARA S, LEE JC. Classification of typical and atypical antipsychotic drugs on the basis of dopamine D1, D2 and serotonin 2, pKi values. J Pharmacol Exp The, 251:238-246, 1989.

  28. METERISSIAN GB: Risperidone induced neuroleptic malignant syndrome; a case report and review. Can J Psychiatry, 41:52-54, 1996.

  29. NORDSTROM AL, FARDE L, WIESEL FA, FORSLUND K, PAULI S, HALLDIN C, UPPFELDT G: Central D2 dopamine receptor occupancy in relation to antipsychotic drug effects: a double-blind PET study if schizophrenic patients. Biol Psychiatry, 33:227-235, 1993.

  30. NYBERG S, FARDE L, HALLDIN C: A PET study of 5- HT2 and D2 dopamine receptor occupancy in the living human brain: a PET study with risperidone. Psychopharmacology (Ber), 110:265-272, 1993.

  31. OSBORN D, WARNER J: Assessing the physical health of psychiatric patients. Psychiatr Bull, 22:695-697, 1998.

  32. PAILLERE-MARTINOT M-L, LECRUBIER Y, MARTINOT J-L, AUBIN F: Improvement of some schizophrenic deficit symptoms with low doses of amisulpride. Am J Psychiatry, 152:130-133, 1995.

  33. PAYKEL EC, MUELTER PS, DE LA VERGNE PM: Drugs causing weight gain. Br J Psychiatry, 123:501-507, 1973.

  34. PETTY RG. Prolactin and antipsychotic medications: mechanism of action. Schizophr Res , 35(supl):67-73, 1999.

  35. PLANANSKY K, HEILIZER F: Weight changes in relation to the characteristics of patients on chlorpromazine. J Clin Experimental Psychopatology, 20:53-57, 1959.

  36. POPLI AP, KONICKI PE, JURJUS GJ, FULLER MA, JASKIW GE: Clozapine and associated diabetes mellitus. J Clin Psychiatry, 58:108-111, 1997.

  37. REILLY JG, AYIS SA, FERRIER IN, JONES SJ, THOMAS SHL: QTc-Interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet, 355:1048-1052, 2000.

  38. REPORT S: Management decisions on priority pipeline products: MDL 100907 (Company Report). Hoechst Marion Roussel, pp2-3, Frankfurt, 1999.

  39. RINETTI G, CAMARENA B, CRUZ C, APIQUIAN R,FRESAN A, PAEZ F, NICOLINI H: Dopamine DRD4 gene polymorphism in first psychotic episode. Arch Med Res, 32:35-38, 2001.

  40. SALLER CF, SALAMA AI: Seroquel: biochemical profile of a potential atypical antipsychotic. Psychopharmacology (Berl), 112:285-292, 1993.

  41. SCHOEMAKER H, CLAUSTRE Y, FAGE D y cols.: Neurochemical characteristics of amisulpride, an atypical dopamine D2/D3 receptor antagonist with both presynaptic and limbic selectivity. J Pharmarcol Exp Ther, 280(1):83-97,1997.

  42. SEEMAN P, VAN TOL HHM: Dopamine receptor pharmacology. Trends Pharmacol Sci, 15:164-270, 1994.

  43. SHIWACH RS, CARMODY TJ: Prolactogenic effects of risperidone in male patients: a preliminary study. Acta Psychiatr Scand, 98:81-83, 1998.

  44. SILVERSTONE T, SMITH G, GOODALL E: Prevalence of obesity in patients receiving depot antipsychotics. Br J Psychiatry, 153:214-217, 1988.

  45. TAUSCHER J, KÜFFERLE B, ASENBAUM S: In vivo 123I IBZM SPECT imaging of striatal dopamine-2 receptor occupancy in schizophrenic patients treated with olanzapine in comparison to clozapine and haloperidol. Psychopharmacology, 141:175-181, 1999.

  46. TRICHARD C, PAILLERE-MARTINOT M-L, ATTALEVY D, RECASSENS C, MONNET F, MARTINOT J-L: Binding of antipsychotic drugs to cortical 5HT-2A receptors: a PET study of chlorpromazine, clozapine and amisulpride in schizophrenic patients. Am J Psychiatry, 155:505-508, 1998.

  47. TRUFFINET P, TAMMINGA CA, FABRE LF, MELTZER HY, RIVIERE ME, PAPILLON-DOWNEY C: Placebocontrolled study of the D4/5-HT2A antagonist fananserin in the treatment of schizophrenia. Am J Psychiatry, 156:419-425, 1999.

  48. TURRONE P, KAPUR S, SEEMAN MV, BROWN GM, RAHMAN MZ, FLINT A: Olanzapine and clozapine elevate prolactin after every daily dose (abstract). Biol Psychiatry, 47 (8 supl):155, 2000.

  49. UMBRICHT DSG, POLLACK S, KANE JM: Clozapine and weight gain. J Clin Psychiatry, 55(9 supl B):157-160, 1994.

  50. WEINBERG DR, BERMAN KF ILLOWSKY BP: Physiological dysfunction of dorsolateral prefrontal cortex in schizophrenia. III. A new cohort and evidence of a monoaminergic mechanism. Arch Gen Psychiatry, 45:609-615,1988.

  51. WIRSHING DA, MARDER SR, WIRSHING WC, SAUNDERS SC, ROSSOTTO EH, ERHART SM: Atypical antipsychotics: a practical review. Medscape 1997; http:// www.medscape.com

  52. WIRSHING DA, WIRSHING WC, KYSAR L, ET AL:Novel antipsychotics: comparison of weight gain liabilities. J Clin Psychiatry, 60:358-363, 1999.

  53. WIRSHING DA, ERHART, SM, PIERRE, JM, BOYD, JA:Nonextrapyramidal side effects of novel antipsychotics. Curr Opin Psychiatry, 13(1):45-50, 2000.




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