From HandWiki
Short description: Class of medications
Drug class
Olanzapine, an example of a second-generation (atypical) antipsychotic
Class identifiers
SynonymsNeuroleptics, major tranquilizers[1]
UsePrincipally: Schizophrenia, Schizoaffective disorder, Dementia, Tourette syndrome, Bipolar disorder, irritability in autism spectrum disorder
Clinical data
Drugs.comDrug Classes
External links

Antipsychotics, also known as neuroleptics,[1] are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders.[2][3] They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.[4]

Prior research has shown that use of any antipsychotic is associated with smaller brain tissue volumes,[5][6] including white matter reduction[7] and that this brain shrinkage is dose dependent and time dependent.[5][6] A more recent controlled trial suggests that second generation antipsychotics[8] combined with intensive psychosocial therapy[9] may potentially prevent pallidal brain volume loss in first episode psychosis.[10][7]

The use of antipsychotics may result in many unwanted side effects such as involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce adverse effects such as tardive dyskinesia, tardive dystonia, and tardive akathisia.

Prevention of these adverse effects is possible through concomitant medication strategies including use of beta-blockers. Currently, treatments for tardive diseases are not well established.

First-generation antipsychotics (e.g. chlorpromazine), known as typical antipsychotics, were first introduced in the 1950s, and others were developed until the early 1970s.[11] Second-generation antipsychotics, known as atypical antipsychotics, were introduced firstly with clozapine in the early 1970s followed by others (e.g. risperidone).[12] Both generations of medication block receptors in the brain for dopamine, but atypicals tend to act on serotonin receptors as well. Neuroleptic, originating from Greek: νεῦρον (neuron) and λαμβάνω (take hold of)—thus meaning "which takes the nerve"—refers to both common neurological effects and side effects.[13]

Medical uses

Antipsychotics are most frequently used for the following conditions:

  • Schizophrenia[2]
  • Schizoaffective disorder most commonly in conjunction with either an antidepressant (in the case of the depressive subtype) or a mood stabiliser (in the case of the bipolar subtype).
  • Bipolar disorder (acute mania and mixed episodes) may be treated with either typical or atypical antipsychotics, although atypical antipsychotics are usually preferred because they tend to have more favourable adverse effect profiles[14] and, according to a recent meta-analysis, they tend to have a lower liability for causing conversion from mania to depression.[15]
  • Psychotic depression. In this indication it is a common practice for the psychiatrist to prescribe a combination of an atypical antipsychotic and an antidepressant as this practice is best supported by the evidence.[16]
  • Treatment resistant depression as an adjunct to standard antidepressant therapy.[16]

Antipsychotics are generally not recommended for treating behavioral problems associated with dementia, given that the risk of use tends to be greater than the potential benefit.[17] The same can be said for insomnia, in which they are not recommended as first-line therapy.[17] There are evidence-based indications for using antipsychotics in children (e.g. tic disorder, bipolar disorder, psychosis), but the use of antipsychotics outside of those contexts (e.g. to treat behavioral problems) warrants significant caution.[17]

Antipsychotics are used to treat tics associated with Tourette syndrome.[18] Aripiprazole, an atypical antipsychotic, is used as add-on medication to ameliorate sexual dysfunction as a symptom of Selective serotonin reuptake inhibitor antidepressants in women.[19]:10 Quetiapine is used to treat generalized anxiety disorder.[20]


Antipsychotic drug treatment is a key component of schizophrenia treatment recommendations by the National Institute of Health and Care Excellence (NICE),[21] the American Psychiatric Association,[22] and the British Society for Psychopharmacology.[23] The main aim of treatment with antipsychotics is to reduce the positive symptoms of psychosis that include delusions and hallucinations.[2] There is mixed evidence to support a significant impact of antipsychotic use on primary negative symptoms (such as apathy, lack of emotional affect, and lack of interest in social interactions) or on the cognitive symptoms (memory impairments, reduced ability to plan and execute tasks).[24][25] In general, the efficacy of antipsychotic treatment in reducing positive symptoms appears to increase with increasing severity of baseline symptoms.[26] All antipsychotic medications work relatively the same way, by antagonizing D2 dopamine receptors. However, there are some differences when it comes to typical and atypical antipsychotics. For example, atypical antipsychotic medications have been seen to lower the neurocognitive impairment associated with schizophrenia more so than conventional antipsychotics, although the reasoning and mechanics of this are still unclear to researchers.[27]

Applications of antipsychotic drugs in the treatment of schizophrenia include prophylaxis in those showing symptoms that suggest that they are at high risk of developing psychosis, treatment of first episode psychosis, maintenance therapy (a form of prophylaxis, maintenance therapy aims to maintain therapeutic benefit and prevent symptom relapse), and treatment of recurrent episodes of acute psychosis.[2][23]

Prevention of psychosis and symptom improvement

Test batteries such as the PACE (Personal Assessment and Crisis Evaluation Clinic) and COPS (Criteria of Prodromal Syndromes), which measure low-level psychotic symptoms and cognitive disturbances, are used to evaluate people with early, low-level symptoms of psychosis. Test results are combined with family history information to identify patients in the "high-risk" group; they are considered to have a 20–40% risk of progression to frank psychosis within two years.[23] These patients are often treated with low doses of antipsychotic drugs with the goal of reducing their symptoms and preventing progression to frank psychosis. While generally useful for reducing symptoms, clinical trials to date show little evidence that early use of antipsychotics improves long-term outcomes in those with prodromal symptoms, either alone or in combination with cognitive-behavioral therapy.[28]

First episode psychosis

First episode psychosis (FEP) is the first time that psychotic symptoms are presented. NICE recommends that all persons presenting with first episode psychosis be treated with both an antipsychotic drug, and cognitive behavioral therapy (CBT). NICE further recommends that those expressing a preference for CBT alone are informed that combination treatment is more effective.[21] A diagnosis of schizophrenia is not made at this time as it takes longer to determine by both DSM-5 and ICD-11, and only around 60% of those presenting with a first episode psychosis will later be diagnosed with schizophrenia.[29]

The conversion rate for a first episode drug induced psychosis to bipolar disorder or schizophrenia are lower, with 30% of people converting to either bipolar disorder or schizophrenia.[30] NICE makes no distinction between a substance-induced psychosis, and any other form of psychosis. The rate of conversion differs for different classes of drug.[30]

Pharmacological options for the specific treatment of FEP have been discussed in recent reviews.[31][32] The goals of treatment for FEP include reducing symptoms and potentially improving long-term treatment outcomes. Randomized clinical trials have provided evidence for the efficacy of antipsychotic drugs in achieving the former goal, with first-generation and second generation antipsychotics showing about equal efficacy. Evidence that early treatment has a favorable effect on long term outcomes is equivocal.[21][23]

Recurrent psychotic episodes

Placebo-controlled trials of both first and second generation antipsychotic drugs consistently demonstrate the superiority of active drug to placebo in suppressing psychotic symptoms.[23] A large meta-analysis of 38 trials of antipsychotic drugs in schizophrenia acute psychotic episodes showed an effect size of about 0.5.[33] There is little or no difference in efficacy among approved antipsychotic drugs, including both first- and second-generation agents.[21][34] The efficacy of such drugs is suboptimal. Few patients achieve complete resolution of symptoms. Response rates, calculated using various cutoff values for symptom reduction, are low and their interpretation is complicated by high placebo response rates and selective publication of clinical trial results.[35]

Maintenance therapy

The majority of patients treated with an antipsychotic drug will experience a response within four weeks. The goals of continuing treatment are to maintain suppression of symptoms, prevent relapse, improve quality of life, and support engagement in psychosocial therapy.[2][23]

Maintenance therapy with antipsychotic drugs is clearly superior to placebo in preventing relapse but is associated with weight gain, movement disorders, and high dropout rates.[36] A 3-year trial following persons receiving maintenance therapy after an acute psychotic episode found that 33% obtained long-lasting symptom reduction, 13% achieved remission, and only 27% experienced satisfactory quality of life. The effect of relapse prevention on long term outcomes is uncertain, as historical studies show little difference in long term outcomes before and after the introduction of antipsychotic drugs.[23]

While maintenance therapy clearly reduces the rate of relapses requiring hospitalization, a large observational study in Finland found that, in people that eventually discontinued antipsychotics, the risk of being hospitalized again for a mental health problem or dying increased the longer they were dispensed (and presumably took) antipsychotics prior to stopping therapy. If people did not stop taking antipsychotics, they remained at low risk for relapse and hospitalization compared to those that stopped taking antipsychotics.[37] The authors speculated that the difference may be because the people that discontinued treatment after a longer time had more severe mental illness than those that discontinued antipsychotic therapy sooner.[37]

A significant challenge in the use of antipsychotic drugs for the prevention of relapse is the poor rate of adherence.[2] In spite of the relatively high rates of adverse effects associated with these drugs, some evidence, including higher dropout rates in placebo arms compared to treatment arms in randomized clinical trials, suggest that most patients who discontinue treatment do so because of suboptimal efficacy.[36][38] If someone experiences psychotic symptoms due to nonadherence, they may be compelled to treatment through a process called involuntary commitment, in which they can be forced to accept treatment (including antipsychotics). A person can also be committed to treatment outside of a hospital, called outpatient commitment.

Antipsychotics in long-acting injectable (LAI), or "depot", form have been suggested as a method of decreasing medication nonadherence (sometimes also called non-compliance).[2][39] NICE advises LAIs be offered to patients when preventing covert, intentional nonadherence is a clinical priority.[40] LAIs are used to ensure adherence in outpatient commitment.[2][41] A meta-analysis found that LAIs resulted in lower rates of rehospitalization with a hazard ratio of 0.83, however these results were not statistically significant (the 95% confidence interval was 0.62 to 1.11).[39]

Bipolar disorder

Main page: Medicine:Bipolar disorder

Antipsychotics are routinely used, often in conjunction with mood stabilisers such as lithium/valproate, as a first-line treatment for manic and mixed episodes associated with bipolar disorder.[16][42] The reason for this combination is the therapeutic delay of the aforementioned mood stabilisers (for valproate therapeutic effects are usually seen around five days after treatment is commenced whereas lithium usually takes at least a week[42] before the full therapeutic effects are seen) and the comparatively rapid antimanic effects of antipsychotic drugs.[43] The antipsychotics have a documented efficacy when used alone in acute mania/mixed episodes.[14]

At least five atypical antipsychotics (lumateperone,[44] cariprazine,[45] lurasidone,[46] olanzapine,[47] and quetiapine[48]) have also been found to possess efficacy in the treatment of bipolar depression as a monotherapy, whereas only olanzapine[49] and quetiapine[50][51] have been proven to be effective broad-spectrum (i.e. against all three types of relapse—manic, mixed and depressive) prophylactic (or maintenance) treatments in patients with bipolar disorder. A recent Cochrane review also found that olanzapine had a less favourable risk/benefit ratio than lithium as a maintenance treatment for bipolar disorder.[52]

The American Psychiatric Association and the UK National Institute for Health and Care Excellence recommend antipsychotics for managing acute psychotic episodes in schizophrenia or bipolar disorder, and as a longer-term maintenance treatment for reducing the likelihood of further episodes.[53][54] They state that response to any given antipsychotic can be variable so that trials may be necessary, and that lower doses are to be preferred where possible. A number of studies have looked at levels of "compliance" or "adherence" with antipsychotic regimes and found that discontinuation (stopping taking them) by patients is associated with higher rates of relapse, including hospitalization.


Psychosis and agitation develop in as many as 80 percent of people living in nursing homes.[55] Despite a lack of FDA approval and black-box warnings, atypical antipsychotics are very often prescribed to people with dementia.[55] An assessment for an underlying cause of behavior is needed before prescribing antipsychotic medication for symptoms of dementia.[56] Antipsychotics in old age dementia showed a modest benefit compared to placebo in managing aggression or psychosis, but this is combined with a fairly large increase in serious adverse events. Thus, antipsychotics should not be used routinely to treat dementia with aggression or psychosis, but may be an option in a few cases where there is severe distress or risk of physical harm to others.[57] Psychosocial interventions may reduce the need for antipsychotics.[58] In 2005, the FDA issued an advisory warning of an increased risk of death when atypical antipsychotics are used in dementia.[55] In the subsequent 5 years, the use of atypical antipsychotics to treat dementia decreased by nearly 50%.[55]

Major depressive disorder

A number of atypical antipsychotics have some benefits when used in addition to other treatments in major depressive disorder.[59][60] Aripiprazole, quetiapine extended-release, and olanzapine (when used in conjunction with fluoxetine) have received the Food and Drug Administration (FDA) labelling for this indication.[61] There is, however, a greater risk of side effects with their use compared to using traditional antidepressants.[59] The greater risk of serious side effects with antipsychotics is why, e.g., quetiapine was denied approval as monotherapy for major depressive disorder or generalized anxiety disorder, and instead was only approved as an adjunctive treatment in combination with traditional antidepressants.[62]


Besides the above uses antipsychotics may be used for obsessive–compulsive disorder, post-traumatic stress disorder, personality disorders, Tourette syndrome, autism and agitation in those with dementia.[63] Evidence however does not support the use of atypical antipsychotics in eating disorders or personality disorder.[64] The atypical antipsychotic risperidone may be useful for obsessive–compulsive disorder.[63] The use of low doses of antipsychotics for insomnia, while common, is not recommended as there is little evidence of benefit as well as concern regarding adverse effects.[64][65] Some of the more serious adverse effects may also occur at the low doses used, such as dyslipidemia and neutropenia,[66][67] and a recent network meta-analysis of 154 double-blind, randomized controlled trials of drug therapies vs. placebo for insomnia in adults found that quetiapine did not demonstrated any short-term benefits in sleep quality.[68] Low dose antipsychotics may also be used in treatment of impulse-behavioural and cognitive-perceptual symptoms of borderline personality disorder.[69] Despite the lack of evidence supporting the benefit of antipsychotics in people with personality disorders, 1 in 4 who do not have a serious mental illness are prescribed them in UK primary care. Many people receive these medication for over a year, contrary to NICE guidelines.[70][71]

In children they may be used in those with disruptive behavior disorders, mood disorders and pervasive developmental disorders or intellectual disability.[72] Antipsychotics are only weakly recommended for Tourette syndrome, because although they are effective, side effects are common.[73] The situation is similar for those on the autism spectrum.[74] Much of the evidence for the off-label use of antipsychotics (for example, for dementia, OCD, PTSD, Personality Disorders, Tourette's) was of insufficient scientific quality to support such use, especially as there was strong evidence of increased risks of stroke, tremors, significant weight gain, sedation, and gastrointestinal problems.[75] A UK review of unlicensed usage in children and adolescents reported a similar mixture of findings and concerns.[76] A survey of children with pervasive developmental disorder found that 16.5% were taking an antipsychotic drug, most commonly for irritability, aggression, and agitation. Both risperidone and aripiprazole have been approved by the US FDA for the treatment of irritability in autistic children and adolescents.[77]

Aggressive challenging behavior in adults with intellectual disability is often treated with antipsychotic drugs despite lack of an evidence base. A recent randomized controlled trial, however, found no benefit over placebo and recommended that the use of antipsychotics in this way should no longer be regarded as an acceptable routine treatment.[78]

Antipsychotics may be an option, together with stimulants, in people with ADHD and aggressive behavior when other treatments have not worked.[79] They have not been found to be useful for the prevention of delirium among those admitted to hospital.[80]

Typicals vs atypicals

It is unclear whether the atypical (second-generation) antipsychotics offer advantages over older, first generation antipsychotics.[2][25][81] Amisulpride, olanzapine, risperidone and clozapine may be more effective but are associated with greater side effects.[82] Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages.[83]

Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia),[84] but it has the potentially serious side effect of agranulocytosis (lowered white blood cell count) in less than 4% of people.[85]

Due to bias in the research the accuracy of comparisons of atypical antipsychotics is a concern.[86]

In 2005, a US government body, the National Institute of Mental Health published the results of a major independent study (the CATIE project).[87] No other atypical studied (risperidone, quetiapine, and ziprasidone) did better than the typical perphenazine on the measures used, nor did they produce fewer adverse effects than the typical antipsychotic perphenazine, although more patients discontinued perphenazine owing to extrapyramidal effects compared to the atypical agents (8% vs. 2% to 4%).[14]

Atypical antipsychotics do not appear to lead to improved rates of medication adherence compared to typical antipsychotics.[88]

Many researchers question the first-line prescribing of atypicals over typicals, and some even question the distinction between the two classes.[89][90][91] In contrast, other researchers point to the significantly higher risk of tardive dyskinesia and other extrapyramidal symptoms with the typicals and for this reason alone recommend first-line treatment with the atypicals, notwithstanding a greater propensity for metabolic adverse effects in the latter.[92] The UK government organization NICE recently revised its recommendation favoring atypicals, to advise that the choice should be an individual one based on the particular profiles of the individual drug and on the patient's preferences.

The re-evaluation of the evidence has not necessarily slowed the bias toward prescribing the atypicals.[93]

Adverse effects

Generally, more than one antipsychotic drug should not be used at a time because of increased adverse effects.[94]

Some atypicals are associated with considerable weight gain, diabetes and the risk of metabolic syndrome.[95] Unwanted side effects cause people to stop treatment, resulting in relapses.[96] Risperidone (atypical) has a similar rate of extrapyramidal symptoms to haloperidol (typical).[95] A rare but potentially lethal condition of neuroleptic malignant syndrome (NMS) has been associated with the use of antipsychotics. Through its early recognition, and timely intervention rates have declined. However, an awareness of the syndrome is advised to enable intervention.[97] Another less rare condition of tardive dyskinesia can occur due to long-term use of antipsychotics, developing after months or years of use. It is more often reported with use of typical antipsychotics.[98] Very rarely antipsychotics may cause tardive psychosis.[99]

Clozapine is associated with side effects that include weight gain, tiredness, and hypersalivation. More serious adverse effects include seizures, NMS, neutropenia, and agranulocytosis (lowered white blood cell count) and its use needs careful monitoring.[100][101]

Clozapine is also associated with thromboembolism (including pulmonary embolism), myocarditis, and cardiomyopathy.[102][103] A systematic review of clozapine-associated pulmonary embolism indicates that this adverse effect can often be fatal, and that it has an early onset, and is dose-dependent. The findings advised the consideration of using a prevention therapy for venous thromboembolism after starting treatment with clozapine, and continuing this for six months.[103] Constipation is three times more likely to occur with the use of clozapine, and severe cases can lead to ileus and bowel ischemia resulting in many fatalities.[100] Very rare clozapine adverse effects include periorbital edema due to several possible mechanisms (e.g. inhibition of platelet-derived growth factor receptors leading to increased vascular permeability, antagonism of renal dopamine receptors with electrolyte and fluid imbalance and immune-mediated hypersensitivity reactions).[104]

However, the risk of serious adverse effects from clozapine is low, and there are the beneficial effects to be gained of a reduced risk of suicide, and aggression.[105][106] Typical antipsychotics and atypical risperidone can have a side effect of sexual dysfunction.[107] Clozapine, olanzapine, and quetiapine are associated with beneficial effects on sexual functioning helped by various psychotherapies.[108]

By rate

Common (≥ 1% and up to 50% incidence for most antipsychotic drugs) adverse effects of antipsychotics include:[109]

  • Sedation (particularly common with asenapine, clozapine, olanzapine, quetiapine, chlorpromazine and zotepine[34])
  • Headaches
  • Dizziness
  • Diarrhea
  • Anxiety
  • Extrapyramidal side effects (particularly common with first-generation antipsychotics), which include:
- Akathisia, an often distressing sense of inner restlessness.
- Dystonia, an abnormal muscle contraction
- Pseudoparkinsonism, symptoms that are similar to what people with Parkinson's disease experience, including tremulousness and drooling
- Galactorrhoea, the unusual secretion of breast milk.
- Gynaecomastia, abnormal growth of breast tissue
- Sexual dysfunction (in both sexes)
- Osteoporosis
  • Orthostatic hypotension
  • Weight gain (particularly prominent with clozapine, olanzapine, quetiapine and zotepine[34])
  • Anticholinergic side-effects (common for olanzapine, clozapine; less likely on risperidone[110]) such as:
- Blurred vision
- Constipation
- Dry mouth (although hypersalivation may also occur)
- Reduced perspiration
  • Tardive dyskinesia appears to be more frequent with high-potency first-generation antipsychotics, such as haloperidol, and tends to appear after chronic and not acute treatment. It is characterized by slow (hence the tardive) repetitive, involuntary and purposeless movements, most often of the face, lips, legs, or torso, which tend to resist treatment and are frequently irreversible. The rate of appearance of TD is about 5% per year of use of antipsychotic drug (whatever the drug used)
  • breast cancer: a systematic review and meta-analysis of observational studies with over 2 million individuals estimated an association between antipsychotic use and breast cancer by over 30%.[111]

Rare/Uncommon (<1% incidence for most antipsychotic drugs) adverse effects of antipsychotics include:

  • Blood dyscrasias (e.g., agranulocytosis, leukopenia, and neutropaenia), which is more common in patients on clozapine.
  • Metabolic syndrome and other metabolic problems such as type II diabetes mellitus — particularly common with clozapine, olanzapine and zotepine. In American studies African Americans appeared to be at a heightened risk for developing type II diabetes mellitus.[112] Evidence suggests that females are more sensitive to the metabolic side effects of first-generation antipsychotic drugs than males.[113] Metabolic adverse effects appear to be mediated by the following mechanisms:
- Causing weight gain by antagonizing the histamine H1 and serotonin 5-HT2Creceptors[114] and perhaps by interacting with other neurochemical pathways in the central nervous system.[115]
- Autonomic instability, which can manifest with tachycardia, nausea, vomiting, diaphoresis, etc.
- Hyperthermia — elevated body temperature.
- Mental status change (confusion, hallucinations, coma, etc.)
- Muscle rigidity
- Laboratory abnormalities (e.g., elevated creatine kinase, reduced iron plasma levels, electrolyte abnormalities, etc.)

Long-term effects

Some studies have found decreased life expectancy associated with the use of antipsychotics, and argued that more studies are needed.[117][118] Antipsychotics may also increase the risk of early death in individuals with dementia.[119] Antipsychotics typically worsen symptoms in people with depersonalisation disorder.[120] Antipsychotic polypharmacy (prescribing two or more antipsychotics at the same time for an individual) is a common practice but not evidence-based or recommended, and there are initiatives to curtail it.[94][121] Similarly, the use of excessively high doses (often the result of polypharmacy) continues despite clinical guidelines and evidence indicating that it is usually no more effective but is usually more harmful.[94][122] A meta-analysis of observational studies with over two million individuals has suggested a moderate association of antipsychotic use with breast cancer.[123]

Loss of grey matter and other brain structural changes over time are observed amongst people diagnosed with schizophrenia. Meta-analyses of the effects of antipsychotic treatment on grey matter volume and the brain's structure have reached conflicting conclusions. A 2012 meta-analysis concluded that grey matter loss is greater in patients treated with first generation antipsychotics relative to those treated with atypicals, and hypothesized a protective effect of atypicals as one possible explanation.[124] A second meta-analysis suggested that treatment with antipsychotics was associated with increased grey matter loss.[125] Animal studies found that monkeys exposed to both first- and second-generation antipsychotics experience significant reduction in brain volume, resulting in an 8-11% reduction in brain volume over a 17–27 month period.[126]

The National Association of State Mental Health Program Directors said that antipsychotics are not interchangeable and it is recommend including trying at least one weight-neutral treatment for those patients with potential metabolic issues.[127]

Subtle, long-lasting forms of akathisia are often overlooked or confused with post-psychotic depression, in particular when they lack the extrapyramidal aspect that psychiatrists have been taught to expect when looking for signs of akathisia.[128]

Adverse effect on cognitive function[129][130][131] and increased risk of death in people with dementia along with worsening of symptoms has been described in the literature.[132][133]


The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse.[134] Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite.[135] Other symptoms may include restlessness, increased sweating, and trouble sleeping.[135] Less commonly there may be a feeling of the world spinning, numbness, or muscle pains.[135] Symptoms generally resolve after a short period of time.[135]

There is tentative evidence that discontinuation of antipsychotics can result in psychosis.[136] It may also result in recurrence of the condition that is being treated.[137] Rarely tardive dyskinesia can occur when the medication is stopped.[135]

Unexpected psychotic episodes have been observed in patients withdrawing from clozapine. This is referred to as supersensitivity psychosis, not to be equated with tardive dyskinesia.[136][138]

Tardive dyskinesia may abate during withdrawal from the antipsychotic agent, or it may persist.[139]

Withdrawal effects may also occur when switching a person from one antipsychotic to another, (it is presumed due to variations of potency and receptor activity). Such withdrawal effects can include cholinergic rebound, an activation syndrome, and motor syndromes including dyskinesias. These adverse effects are more likely during rapid changes between antipsychotic agents, so making a gradual change between antipsychotics minimises these withdrawal effects.[140] The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotic treatment to avoid acute withdrawal syndrome or rapid relapse.[141] The process of cross-titration involves gradually increasing the dose of the new medication while gradually decreasing the dose of the old medication.

City and Hackney Clinical Commissioning Group found more than 1,000 patients in their area in July 2019 who had not had regular medication reviews or health checks because they were not registered as having serious mental illness. On average they had been taking these drugs for six years. If this is typical of practice in England more than 100,000 patients are probably in the same position.[142]

List of agents


Clinically used antipsychotic medications are listed below by drug group. Trade names appear in parentheses. A 2013 review has stated that the division of antipsychotics into first and second generation is perhaps not accurate.[34]


† indicates drugs that are no longer (or were never) marketed in English-speaking countries.

‡ denotes drugs that are no longer (or were never to begin with) marketed in the United States. Some antipsychotics are not firmly placed in either first-generation or second-generation classes.

# denotes drugs that have been withdrawn worldwide.

First-generation (typical)

Main page: Chemistry:Typical antipsychotic






This category is for drugs that have been called both first and second-generation, depending on the literature being used.




Second-generation (atypical)

Main page: Chemistry:Atypical antipsychotic


  • Amisulpride – Selective dopamine antagonist. Higher doses (greater than 400 mg) act upon post-synaptic dopamine receptors resulting in a reduction in the positive symptoms of schizophrenia, such as psychosis. Lower doses, however, act upon dopamine autoreceptors, resulting in increased dopamine transmission, improving the negative symptoms of schizophrenia. Lower doses of amisulpride have also been shown to have antidepressant and anxiolytic effects in non-schizophrenic patients, leading to its use in dysthymia and social phobias.
  • Nemonapride – Used in Japan.
  • Remoxipride # – Has a risk of causing aplastic anaemia and, hence, has been withdrawn from the market worldwide. It has also been found to possess relatively low (virtually absent) potential to induce hyperprolactinaemia and extrapyramidal symptoms, likely attributable to its comparatively weak binding to (and, hence, rapid dissociation from) the D2 receptor.[143]
  • Sultopride – An atypical antipsychotic of the benzamide chemical class used in Europe, Japan, and Hong Kong for the treatment of schizophrenia. It was launched by Sanofi-Aventis in 1976. Sultopride acts as a selective D2 and D3 receptor antagonist.


  • Lumateperone – In December 2019, lumateperone received its first global approval in the USA for the treatment of schizophrenia in adults.[144] In 2020 and 2021 FDA approved for depressive episodes associated with bipolar I or II disorder (bipolar depression) in adults, as monotherapy and as adjunctive therapy with lithium or valproate.
  • Iloperidone – Approved by the US FDA in 2009, it is fairly well tolerated, although hypotension, dizziness, and somnolence were very common side effects. Has not received regulatory approval in other countries, however.
  • Paliperidone – Primary, active metabolite of risperidone that was approved in 2006.
  • Perospirone – Has a higher incidence of extrapyramidal side effects than other atypical antipsychotics.[145]
  • Risperidone – Divided dosing is recommended until initial titration is completed, at which time the drug can be administered once daily. Used off-label to treat Tourette syndrome and anxiety disorder.
  • Ziprasidone – Approved in 2004[146] to treat bipolar disorder. Side-effects include a prolonged QT interval in the heart, which can be dangerous for patients with heart disease or those taking other drugs that prolong the QT interval.


  • Melperone – Only used in a few European countries. No English-speaking country has licensed it to date.
  • Lumateperone


  • Asenapine – Used for the treatment of schizophrenia and acute mania associated with bipolar disorder.
  • Clozapine – Requires routine laboratory monitoring of complete blood counts every one to four weeks due to the risk of agranulocytosis. It has unparalleled efficacy in the treatment of treatment-resistant schizophrenia.
  • Olanzapine – Used to treat psychotic disorders including schizophrenia, acute manic episodes, and maintenance of bipolar disorder. Used as an adjunct to antidepressant therapy, either alone or in combination with fluoxetine as Symbyax.
  • Quetiapine – Used primarily to treat bipolar disorder and schizophrenia. Also used and licensed in a few countries (including Australia, the United Kingdom and the United States) as an adjunct to antidepressant therapy in patients with major depressive disorder. It's the only antipsychotic that's demonstrated efficacy as a monotherapy for the treatment of major depressive disorder. It indirectly serves as a norepinephrine reuptake inhibitor by means of its active metabolite, norquetiapine.
  • Zotepine – An atypical antipsychotic indicated for acute and chronic schizophrenia. It is still used in Japan and was once used in Germany but it was discontinued.


  • Blonanserin – Approved by the PMDA in 2008. Used in Japan and South Korea.
  • Pimavanserin – A selective 5-HT2A receptor antagonist approved for the treatment of Parkinson's disease psychosis in 2016.
  • Sertindole – Developed by the Danish pharmaceutical company H. Lundbeck. Like the other atypical antipsychotics, it is believed to have antagonist activity at dopamine and serotonin receptors in the brain.


Third generation antipsychotics are recognized as demonstrating D2 receptor agonism as opposed to the D2 receptor antagonistic mechanism of both first-generation (typical) and second-generation (atypical) antipsychotic medications.[147]


  • Lurasidone (Latuda) – Approved by the US FDA for schizophrenia and bipolar depression, and for use as schizophrenia treatment in Canada.

Mechanism of action

Antipsychotic drugs such as haloperidol and chlorpromazine tend to block dopamine D2 receptors in the dopaminergic pathways of the brain. This means that dopamine released in these pathways has less effect. Excess release of dopamine in the mesolimbic pathway has been linked to psychotic experiences. Decreased dopamine release in the prefrontal cortex, and excess dopamine release in other pathways, are associated with psychotic episodes in schizophrenia and bipolar disorder.[149][150]

In addition to the antagonistic effects of dopamine, antipsychotics (in particular atypical neuroleptics) also antagonize 5-HT2A receptors. Different alleles of the 5-HT2A receptor have been associated with schizophrenia and other psychoses, including depression.[151][152] Higher concentrations of 5-HT2A receptors in cortical and subcortical areas, in particular in the right caudate nucleus have been historically recorded.[151]

Typical antipsychotics are not particularly selective and also block dopamine receptors in the mesocortical pathway, tuberoinfundibular pathway, and the nigrostriatal pathway. Blocking D2 receptors in these other pathways is thought to produce some unwanted side effects that the typical antipsychotics can produce (see above). They were commonly classified on a spectrum of low potency to high potency, where potency referred to the ability of the drug to bind to dopamine receptors, and not to the effectiveness of the drug. High-potency antipsychotics such as haloperidol, in general, have doses of a few milligrams and cause less sleepiness and calming effects than low-potency antipsychotics such as chlorpromazine and thioridazine, which have dosages of several hundred milligrams. The latter have a greater degree of anticholinergic and antihistaminergic activity, which can counteract dopamine-related side-effects.[153]

Atypical antipsychotic drugs have a similar blocking effect on D2 receptors; however, most also act on serotonin receptors, especially 5-HT2A and 5-HT2C receptors. Both clozapine and quetiapine appear to bind just long enough to elicit antipsychotic effects but not long enough to induce extrapyramidal side effects and prolactin hypersecretion.[154] 5-HT2A antagonism increases dopaminergic activity in the nigrostriatal pathway, leading to a lowered extrapyramidal side effect liability among the atypical antipsychotics.[154][155]

Comparison of medications


Advertisement for Thorazine (chlorpromazine) from the 1950s, reflecting the perceptions of psychosis, including the now-discredited perception of a tendency towards violence, from the time when antipsychotics were discovered[240]

The original antipsychotic drugs were happened upon largely by chance and then tested for their effectiveness. The first, chlorpromazine, was developed as a surgical anesthetic. It was first used on psychiatric patients because of its powerful calming effect; at the time it was regarded as a non-permanent "pharmacological lobotomy".[241] Lobotomy at the time was used to treat many behavioral disorders, including psychosis, although its effect was to markedly reduce behavior and mental functioning of all types. However, chlorpromazine proved to reduce the effects of psychosis in a more effective and specific manner than lobotomy, even though it was known to be capable of causing severe sedation. The underlying neurochemistry involved has since been studied in detail, and subsequent antipsychotic drugs have been developed by rational drug design.

The discovery of chlorpromazine's psychoactive effects in 1952 led to further research that resulted in the development of antidepressants, anxiolytics, and the majority of other drugs now used in the management of psychiatric conditions. In 1952, Henri Laborit described chlorpromazine only as inducing indifference towards what was happening around them in nonpsychotic, nonmanic patients, and Jean Delay and Pierre Deniker described it as controlling manic or psychotic agitation. The former claimed to have discovered a treatment for agitation in anyone, and the latter team claimed to have discovered a treatment for psychotic illness.[242]

Until the 1970s there was considerable debate within psychiatry on the most appropriate term to use to describe the new drugs.[13] In the late 1950s the most widely used term was "neuroleptic", followed by "major tranquilizer" and then "ataraxic".[13] The first recorded use of the term tranquilizer dates from the early nineteenth century.[243] In 1953 Frederik F. Yonkman, a chemist at the Swiss-based Cibapharmaceutical company, first used the term tranquilizer to differentiate reserpine from the older sedatives.[244] The word neuroleptic was coined in 1955 by Delay and Deniker after their discovery (1952) of the antipsychotic effects of chlorpromazine.[13] It is derived from the Greek: "νεῦρον" (neuron, originally meaning "sinew" but today referring to the nerves) and "λαμβάνω" (lambanō, meaning "take hold of"). Thus, the word means taking hold of one's nerves. It was often taken to refer also to common side effects such as reduced activity in general, as well as lethargy and impaired motor control. Although these effects are unpleasant and in some cases harmful, they were at one time, along with akathisia, considered a reliable sign that the drug was working.[241] The term "ataraxy" was coined by the neurologist Howard Fabing and the classicist Alister Cameron to describe the observed effect of psychic indifference and detachment in patients treated with chlorpromazine.[245] This term derived from the Greek adjective "ἀτάρακτος" (ataraktos), which means "not disturbed, not excited, without confusion, steady, calm".[13] In the use of the terms "tranquilizer" and "ataractic", medical practitioners distinguished between the "major tranquilizers" or "major ataractics", which referred to drugs used to treat psychoses, and the "minor tranquilizers" or "minor ataractics", which referred to drugs used to treat neuroses.[13] While popular during the 1950s, these terms are infrequently used today. They are being abandoned in favor of "antipsychotic", which refers to the drug's desired effects.[13] Today, "minor tranquilizer" can refer to anxiolytic and/or hypnotic drugs such as the benzodiazepines and nonbenzodiazepines, which are useful as generally short-term management for insomnia together with cognitive behavioral therapy for insomnia.[246][247] They are potentially addictive sedatives.

Antipsychotics are broadly divided into two groups, the typical or first-generation antipsychotics and the atypical or second-generation antipsychotics. The difference between first- and second-generation antipsychotics is a subject of debate. The second-generation antipsychotics are generally distinguishable by the presence of 5HT2A receptor antagonism and a corresponding lower propensity for extrapyramidal side effects compared to first-generation antipsychotics.[13]

Society and culture


The term major tranquilizer was used for older antipsychotic drugs. The term neuroleptic is often used as a synonym for antipsychotic, even though – strictly speaking – the two terms are not interchangeable. Antipsychotic drugs are a subgroup of neuroleptic drugs, because the latter have a wider range of effects.[248][249]

Antipsychotics are a type of psychoactive or psychotropic medication.[250][251]


Antipsychotics were once among the biggest selling and most profitable of all drugs, generating $22 billion in global sales in 2008.[252] By 2003 in the US, an estimated 3.21 million patients received antipsychotics, worth an estimated $2.82 billion. Over 2/3 of prescriptions were for the newer, more expensive atypicals, each costing on average $164 per year, compared to $40 for the older types.[253] By 2008, sales in the US reached $14.6 billion, the biggest selling drugs in the US by therapeutic class.[254]

In the five years since July 2017 the number of antipsychotic medicines dispensed in the community in the United Kingdom has increased by 11.2%. There have also been substantial price rises. Risperidone 6 mg tablets, the largest, increased from £3.09 in July 2017 to £41.16 in June 2022. The NHS is spending an additional £33 million annually on antipsychotics. Haloperidol 500 microgram tablets constituted £14.3 million of this.[255]


Antipsychotics in the nursing home population are often overprescribed, often for the purposes of making it easier to handle dementia patients. Federal efforts to reduce the use of antipsychotics in US nursing homes has led to a nationwide decrease in their usage in 2012.[256][257][258]


Antipsychotics are sometimes administered as part of compulsory psychiatric treatment via inpatient (hospital) commitment or outpatient commitment.


They may be administered orally or, in some cases, through long-acting (depot) injections administered in the dorsgluteal, ventrogluteal or deltoid muscle. Short-acting parenteral formulations also exist, which are generally reserved for emergencies or when oral administration is otherwise impossible. The oral formulations include immediate release, extended release, and orally disintegrating products (which are not sublingual, and can help ensure that medications are swallowed instead of "cheeked"). Sublingual products (e.g. asenapine) also exist, which must be held under the tongue for absorption. The first transdermal formulation of an antipsychotic (transdermal asenapine, marketed as Secuado), was FDA-approved in 2019.[259]

Recreational use

Certain second-generation antipsychotics are misused or abused for their sedative, tranquilizing, and (paradoxically) "hallucinogenic" effects.[260] The most commonly second-generation antipsychotic implicated is quetiapine.[260] In case reports, quetiapine has been abused in doses taken by mouth (which is how the drug is available from the manufacturer), but also crushed and insufflated or mixed with water for injection into a vein.[260] Olanzapine, another sedating second-generation antipsychotic, has also been misused for similar reasons.[260] There is no standard treatment for antipsychotic abuse, though switching to a second-generation antipsychotic with less abuse potential (e.g. aripiprazole) has been used.[260]


Joanna Moncrieff has argued that antipsychotic drug treatment is often undertaken as a means of control rather than to treat specific symptoms experienced by the patient.[261]

Use of this class of drugs has a history of criticism in residential care. As the drugs used can make patients calmer and more compliant, critics claim that the drugs can be overused. Outside doctors can feel under pressure from care home staff.[262] In an official review commissioned by UK government ministers it was reported that the needless use of antipsychotic medication in dementia care was widespread and was linked to 1800 deaths per year.[263][264] In the US, the government has initiated legal action against the pharmaceutical company Johnson & Johnson for allegedly paying kickbacks to Omnicare to promote its antipsychotic risperidone (Risperdal) in nursing homes.[265]

There has also been controversy about the role of pharmaceutical companies in marketing and promoting antipsychotics, including allegations of downplaying or covering up adverse effects, expanding the number of conditions or illegally promoting off-label usage; influencing drug trials (or their publication) to try to show that the expensive and profitable newer atypicals were superior to the older cheaper typicals that were out of patent. Following charges of illegal marketing, settlements by two large pharmaceutical companies in the US set records for the largest criminal fines ever imposed on corporations.[266] One case involved Eli Lilly and Company's antipsychotic Zyprexa, and the other involved Bextra. In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic, Geodon.[266] In addition, AstraZeneca faces numerous personal-injury lawsuits from former users of Seroquel (quetiapine), amidst federal[clarification needed] investigations of its marketing practices.[267] By expanding the conditions for which they were indicated, Astrazeneca's Seroquel and Eli Lilly's Zyprexa had become the biggest selling antipsychotics in 2008 with global sales of $5.5 billion and $5.4 billion respectively.[252]

Harvard University medical professor Joseph Biederman conducted research on bipolar disorder in children that led to an increase in such diagnoses. A 2008 Senate investigation found that Biederman also received $1.6 million in speaking and consulting fees between 2000 and 2007, some of them undisclosed to Harvard, from companies including makers of antipsychotic drugs prescribed for children with bipolar disorder. Johnson & Johnson gave more than $700,000 to a research center that was headed by Biederman from 2002 to 2005, where research was conducted, in part, on Risperdal, the company's antipsychotic drug. Biederman has responded saying that the money did not influence him and that he did not promote a specific diagnosis or treatment.[266]

Pharmaceutical companies have also been accused of attempting to set the mental health agenda through activities such as funding consumer advocacy groups.[268]

Special populations

It is recommended that persons with dementia who exhibit behavioral and psychological symptoms should not be given antipsychotics before trying other treatments.[269] When taking antipsychotics this population has increased risk of cerebrovascular effects, parkinsonism or extrapyramidal symptoms, sedation, confusion and other cognitive adverse effects, weight gain, and increased mortality.[269] Physicians and caretakers of persons with dementia should try to address symptoms including agitation, aggression, apathy, anxiety, depression, irritability, and psychosis with alternative treatments whenever antipsychotic use can be replaced or reduced.[269] Elderly persons often have their dementia treated first with antipsychotics and this is not the best management strategy.[270]

See also


  1. Bolded drug names indicates drugs that are metabolites of clinically-marketed antipsychotics


  1. 1.0 1.1 (in en) Pharmacology. Lippincott Williams & Wilkins. 2009. p. 151. ISBN 9780781771559. 
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 "Comparing 1-year effectiveness and acceptability of once-monthly paliperidone palmitate and aripiprazole monohydrate for schizophrenia spectrum disorders: Findings from the STAR Network Depot Study". Psychiatry Research 309: 114405. March 2022. doi:10.1016/j.psychres.2022.114405. PMID 35093701. 
  3. "Antipsychotic medication in schizophrenia: a review". British Medical Bulletin 114 (1): 169–79. June 2015. doi:10.1093/bmb/ldv017. PMID 25957394. "Antipsychotic medications are mainstays in the treatment of schizophrenia and a range of other psychotic disorders.". 
  4. "Bipolar disorder". Lancet 387 (10027): 1561–1572. April 2016. doi:10.1016/S0140-6736(15)00241-X. PMID 26388529. 
  5. 5.0 5.1 "Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia". Archives of General Psychiatry 68 (2): 128–137. February 2011. doi:10.1001/archgenpsychiatry.2010.199. PMID 21300943. 
  6. 6.0 6.1 "A systematic review of the effects of antipsychotic drugs on brain volume". Psychological Medicine 40 (9): 1409–1422. September 2010. doi:10.1017/S0033291709992297. PMID 20085668. 
  7. 7.0 7.1 "Differentiating the effect of antipsychotic medication and illness on brain volume reductions in first-episode psychosis: A Longitudinal, Randomised, Triple-blind, Placebo-controlled MRI Study". Neuropsychopharmacology 46 (8): 1494–1501. July 2021. doi:10.1038/s41386-021-00980-0. PMID 33637835. 
  8. please see Chopra et al 2021: Strengths and limitations "only examined risperidone and paliperidone"
  9. please see Chopra et al 2021: Method Study design
  10. please see Chopra et al 2021: Introduction, 3rd paragraph, Lieberman JA, et al. 2005 & Shao Y et al 2015, and Chopra et al: Are antipsychotics neuroprotective? 1st paragraph last sentence
  11. "A history of antipsychotic drug development". Comprehensive Psychiatry 40 (6): 407–14. December 1999. doi:10.1016/s0010-440x(99)90082-2. PMID 10579370. 
  12. "Molecular targets of atypical antipsychotics: From mechanism of action to clinical differences". Pharmacology & Therapeutics 192: 20–41. December 2018. doi:10.1016/j.pharmthera.2018.06.012. PMID 29953902. 
  13. 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 "What's in a name? The evolution of the nomenclature of antipsychotic drugs". Journal of Psychiatry & Neuroscience 27 (3): 168–175. May 2002. PMID 12066446. 
  14. 14.0 14.1 14.2 14.3 14.4 "Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis". Lancet 373 (9657): 31–41. January 2009. doi:10.1016/S0140-6736(08)61764-X. PMID 19058842. 
  15. "Lower rate of depressive switch following antimanic treatment with second-generation antipsychotics versus haloperidol". Journal of Affective Disorders 144 (3): 191–8. January 2013. doi:10.1016/j.jad.2012.07.038. PMID 23089129. 
  16. 16.0 16.1 16.2 16.3 16.4 16.5 The Maudsley prescribing guidelines in psychiatry (11th ed.). Chichester, West Sussex, UK: Wiley-Blackwell. 2012. ISBN 978-0-470-97948-8. 
  17. 17.0 17.1 17.2 "American Psychiatric Association Five Things Physicians and Patients Should Question". Choosing Wisely. 
  18. "The role of atypical antipsychotics for treatment of Tourette's syndrome: an overview". Drugs 74 (11): 1177–1193. July 2014. doi:10.1007/s40265-014-0254-0. PMID 25034359. 
  19. "Women's sexual dysfunction associated with psychiatric disorders and their treatment". Women's Health 14: 1745506518762664. 2018-01-01. doi:10.1177/1745506518762664. PMID 29649948. 
  20. "A literature review of quetiapine for generalized anxiety disorder". Pharmacotherapy 35 (2): 175–188. February 2015. doi:10.1002/phar.1529. PMID 25689246. 
  21. 21.0 21.1 21.2 21.3 "Psychosis and schizophrenia in adults (CG178)". 
  22. "PsychiatryOnline | Guidelines". 
  23. 23.0 23.1 23.2 23.3 23.4 23.5 23.6 "Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology". Journal of Psychopharmacology 25 (5): 567–620. May 2011. doi:10.1177/0269881110391123. PMID 21292923. 
  24. "Pharmacological treatment of schizophrenia: a critical review of the pharmacology and clinical effects of current and future therapeutic agents". Molecular Psychiatry 17 (12): 1206–27. December 2012. doi:10.1038/mp.2012.47. PMID 22584864. 
  25. 25.0 25.1 "Antipsychotics in adults with schizophrenia: comparative effectiveness of first-generation versus second-generation medications: a systematic review and meta-analysis". Annals of Internal Medicine 157 (7): 498–511. October 2012. doi:10.7326/0003-4819-157-7-201210020-00525. PMID 22893011. 
  26. "Initial severity of schizophrenia and efficacy of antipsychotics: participant-level meta-analysis of 6 placebo-controlled studies". JAMA Psychiatry 72 (1): 14–21. January 2015. doi:10.1001/jamapsychiatry.2014.2127. PMID 25372935. 
  27. "The effects of atypical antipsychotic drugs on neurocognitive impairment in schizophrenia: a review and meta-analysis". Schizophrenia Bulletin 25 (2): 201–22. 1 January 1999. doi:10.1093/oxfordjournals.schbul.a033374. PMID 10416727. 
  28. "NICE Treatment Guidance 2014". 
  29. "Beyond the "at risk mental state" concept: transitioning to transdiagnostic psychiatry". World Psychiatry 17 (2): 133–142. June 2018. doi:10.1002/wps.20514. PMID 29856558. 
  30. 30.0 30.1 "Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis". The American Journal of Psychiatry (American Psychiatric Association Publishing) 175 (4): 343–350. April 2018. doi:10.1176/appi.ajp.2017.17020223. PMID 29179576. 
  31. "A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes". Schizophrenia Bulletin 41 (6): 1227–1236. November 2015. doi:10.1093/schbul/sbv125. PMID 26338693. 
  32. "Antipsychotic Treatment Effectiveness in First Episode of Psychosis: PAFIP 3-Year Follow-Up Randomized Clinical Trials Comparing Haloperidol, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Ziprasidone". The International Journal of Neuropsychopharmacology 23 (4): 217–229. April 2020. doi:10.1093/ijnp/pyaa004. PMID 31974576. 
  33. "How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials". Molecular Psychiatry 14 (4): 429–47. April 2009. doi:10.1038/ PMID 18180760. 
  34. 34.0 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 "Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis". Lancet 382 (9896): 951–62. September 2013. doi:10.1016/S0140-6736(13)60733-3. PMID 23810019. 
  35. "Comparative remission rates of schizophrenic patients using various remission criteria". Progress in Neuro-Psychopharmacology & Biological Psychiatry 32 (7): 1643–51. October 2008. doi:10.1016/j.pnpbp.2008.06.008. PMID 18616969. 
  36. 36.0 36.1 "Maintenance treatment with antipsychotic drugs for schizophrenia". The Cochrane Database of Systematic Reviews 2020 (8): CD008016. August 2020. doi:10.1002/14651858.CD008016.pub3. PMID 32840872. 
  37. 37.0 37.1 "20-Year Nationwide Follow-Up Study on Discontinuation of Antipsychotic Treatment in First-Episode Schizophrenia". The American Journal of Psychiatry (American Psychiatric Association Publishing) 175 (8): 765–773. August 2018. doi:10.1176/appi.ajp.2018.17091001. PMID 29621900. 
  38. "The temporal relationship between symptom change and treatment discontinuation in a pooled analysis of 4 schizophrenia trials". Journal of Clinical Psychopharmacology 28 (5): 544–9. October 2008. doi:10.1097/JCP.0b013e318185e74a. PMID 18794651. 
  39. 39.0 39.1 "Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis". Clinical Psychopharmacology and Neuroscience 16 (4): 361–375. November 2018. doi:10.9758/cpn.2018.16.4.361. PMID 30466208. 
  41. "Community treatment orders and antipsychotic long-acting injections". The British Journal of Psychiatry. Supplement (Royal College of Psychiatrists) 52 (S52): S57-62. November 2009. doi:10.1192/bjp.195.52.s57. PMID 19880919. 
  42. 42.0 42.1 Applied therapeutics: the clinical use of drugs (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2009. pp. 3040. ISBN 978-0-7817-6555-8. 
  43. "Antipsychotic and mood stabilizer efficacy and tolerability in pediatric and adult patients with bipolar I mania: a comparative analysis of acute, randomized, placebo-controlled trials". Bipolar Disorders 12 (2): 116–41. March 2010. doi:10.1111/j.1399-5618.2010.00798.x. PMID 20402706. 
  44. "DailyMed - CAPLYTA- lumateperone capsule". 
  45. "Cariprazine Treatment of Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Phase 3 Study". The American Journal of Psychiatry 176 (6): 439–448. June 2019. doi:10.1176/appi.ajp.2018.18070824. PMID 30845817. 
  46. "Lurasidone Approved for Bipolar Depression". 
  47. "Efficacy of olanzapine monotherapy in acute bipolar depression: a pooled analysis of controlled studies". Journal of Affective Disorders 149 (1–3): 196–201. July 2013. doi:10.1016/j.jad.2013.01.022. PMID 23485111. 
  48. "Quetiapine monotherapy for bipolar depression". Neuropsychiatric Disease and Treatment 4 (1): 11–21. February 2008. doi:10.2147/ndt.s1162. PMID 18728771. 
  49. "Olanzapine versus lithium in the maintenance treatment of bipolar disorder: a 12-month, randomized, double-blind, controlled clinical trial". The American Journal of Psychiatry 162 (7): 1281–1290. July 2005. doi:10.1176/appi.ajp.162.7.1281. PMID 15994710. 
  50. "Maintenance treatment of adolescent bipolar disorder: open study of the effectiveness and tolerability of quetiapine". BMC Psychiatry 9: 4. February 2009. doi:10.1186/1471-244X-9-4. PMID 19200370. 
  51. "Continuation of quetiapine versus switching to placebo or lithium for maintenance treatment of bipolar I disorder (Trial 144: a randomized controlled study)". The Journal of Clinical Psychiatry 72 (11): 1452–1464. November 2011. doi:10.4088/JCP.11m06878. PMID 22054050. 
  52. "Olanzapine in long-term treatment for bipolar disorder". The Cochrane Database of Systematic Reviews (1): CD004367. January 2009. doi:10.1002/14651858.CD004367.pub2. PMID 19160237. 
  53. "Practice guideline for the treatment of patients with schizophrenia, second edition". The American Journal of Psychiatry 161 (2 Suppl): 1–56. February 2004. PMID 15000267. 
  54. National Collaborating Centre (2009). Schizophrenia. PMID 20704054. Retrieved 2021-03-09. 
  55. 55.0 55.1 55.2 55.3 "An analysis of the intended use of atypical antipsychotics in dementia". Psychiatry 7 (11): 14–17. November 2010. PMID 21191528. 
  56. AMDA – The Society for Post-Acute and Long-Term Care Medicine (February 2014), "Ten Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (AMDA – The Society for Post-Acute and Long-Term Care Medicine),, retrieved 20 April 2015 .
  57. "The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer's disease". The Cochrane Database of Systematic Reviews (1): CD003476. January 2006. doi:10.1002/14651858.CD003476.pub2. PMID 16437455. 
  58. "Psychosocial interventions for reducing antipsychotic medication in care home residents". The Cochrane Database of Systematic Reviews 12 (12): CD008634. December 2012. doi:10.1002/14651858.CD008634.pub2. PMID 23235663. 
  59. 59.0 59.1 "Second-generation antipsychotics for major depressive disorder and dysthymia". The Cochrane Database of Systematic Reviews (12): CD008121. December 2010. doi:10.1002/14651858.CD008121.pub2. PMID 21154393. 
  60. "Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes". PLOS Medicine 10 (3): e1001403. 2013. doi:10.1371/journal.pmed.1001403. PMID 23554581. 
  61. Truven Health Analytics, Inc. DrugPoint System (Internet) [cited 2013 Oct 2]. Greenwood Village, CO: Thomsen Healthcare; 2013.
  62. "FDA Psychopharmacologic Drugs Advisory Committee Hearing". 
  63. 63.0 63.1 "Summary of the comparative effectiveness review on off-label use of atypical antipsychotics". Journal of Managed Care Pharmacy 18 (5 Suppl B): S1-20. June 2012. doi:10.18553/jmcp.2012.18.s5-b.1. PMID 22784311. 
  64. 64.0 64.1 Off-Label Use of Atypical Antipsychotics: An Update. Comparative Effectiveness Reviews, No. 43. Rockville: Agency for Healthcare Research and Quality. 2011. 
  65. "Safety of low doses of quetiapine when used for insomnia". The Annals of Pharmacotherapy 46 (5): 718–722. May 2012. doi:10.1345/aph.1Q697. PMID 22510671. 
  66. "Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis". The Lancet. Psychiatry 7 (1): 64–77. January 2020. doi:10.1016/s2215-0366(19)30416-x. PMID 31860457. 
  67. "Dose-dependent effects of antipsychotics on efficacy and adverse effects in schizophrenia". Behavioural Brain Research 402: 113098. March 2021. doi:10.1016/j.bbr.2020.113098. PMID 33417992. 
  68. "Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis" (in English). Lancet 400 (10347): 170–184. July 2022. doi:10.1016/S0140-6736(22)00878-9. PMID 35843245. 
  69. Work Group on Borderline Personality Disorder (2001). Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. American Psychiatric Association Publications. p. 4. ISBN 978-0890423196. Retrieved 5 June 2013. 
  70. "Antipsychotics are commonly prescribed to people with personality disorders, contrary to guidelines" (in en). NIHR Evidence. 2022-11-10. doi:10.3310/nihrevidence_54520. 
  71. "Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database". BMJ Open 12 (3): e053943. March 2022. doi:10.1136/bmjopen-2021-053943. PMID 35264346. 
  72. "Second generation antipsychotics (SGAs) for non-psychotic disorders in children and adolescents: a review of the randomized controlled studies". European Neuropsychopharmacology 21 (8): 600–20. August 2011. doi:10.1016/j.euroneuro.2011.04.001. PMID 21550212. 
  73. "Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy". Canadian Journal of Psychiatry 57 (3): 133–43. March 2012. doi:10.1177/070674371205700302. PMID 22397999. 
  74. "A systematic review of medical treatments for children with autism spectrum disorders". Pediatrics 127 (5): e1312–21. May 2011. doi:10.1542/peds.2011-0427. PMID 21464191. 
  75. "Evidence Lacking to Support Many Off-label Uses of Atypical Antipsychotics" (Press release). Agency for Healthcare Research and Quality. 17 January 2007. Archived from the original on 25 February 2013. Retrieved 29 July 2013.
  76. "Prescribing antipsychotics for children and adolescents". Advances in Psychiatric Treatment 16 (1): 63–75. 2010. doi:10.1192/apt.bp.108.005652. 
  77. Truven Health Analytics, Inc. DRUGDEX System (Internet) [cited 2013 Oct 10]. Greenwood Village, CO: Thomsen Healthcare; 2013.
  78. "The treatment of challenging behaviour in intellectual disabilities: cost-effectiveness analysis". Journal of Intellectual Disability Research 53 (7): 633–43. July 2009. doi:10.1111/j.1365-2788.2009.01180.x. PMID 19460067. 
  79. "Antipsychotic and psychostimulant drug combination therapy in attention deficit/hyperactivity and disruptive behavior disorders: a systematic review of efficacy and tolerability". Current Psychiatry Reports 15 (5): 355. May 2013. doi:10.1007/s11920-013-0355-6. PMID 23539465. 
  80. "Antipsychotics for Preventing Delirium in Hospitalized Adults: A Systematic Review". Annals of Internal Medicine 171 (7): 474–484. October 2019. doi:10.7326/M19-1859. PMID 31476766. 
  81. "Pharmacologic treatment of schizophrenia". Dialogues in Clinical Neuroscience 12 (3): 345–57. 2010. doi:10.31887/DCNS.2010.12.3/jkane. PMID 20954430. 
  82. "Schizophrenia". BMJ Clinical Evidence 2012. June 2012. PMID 23870705. 
  83. "Schizophrenia: a review". American Family Physician 75 (12): 1821–9. June 2007. PMID 17619525. 
  84. "Refractory schizophrenia and atypical antipsychotics". Journal of Psychopharmacology 14 (4): 409–18. 2000. doi:10.1177/026988110001400411. PMID 11198061. 
  85. "Clozapine versus typical neuroleptic medication for schizophrenia". The Cochrane Database of Systematic Reviews 2009 (1): CD000059. January 2009. doi:10.1002/14651858.CD000059.pub2. PMID 19160174. 
  86. "Why olanzapine beats risperidone, risperidone beats quetiapine, and quetiapine beats olanzapine: an exploratory analysis of head-to-head comparison studies of second-generation antipsychotics". The American Journal of Psychiatry 163 (2): 185–94. February 2006. doi:10.1176/appi.ajp.163.2.185. PMID 16449469. 
  87. "Effectiveness of antipsychotic drugs in patients with chronic schizophrenia". The New England Journal of Medicine 353 (12): 1209–23. September 2005. doi:10.1056/NEJMoa051688. PMID 16172203. 
  88. "New generation antipsychotic drugs and compliance behaviour". Current Opinion in Psychiatry 21 (2): 133–9. March 2008. doi:10.1097/YCO.0b013e3282f52851. PMID 18332660. 
  89. "Quality of evidence in drug compendia supporting off-label use of typical and atypical antipsychotic medications". The International Journal of Risk & Safety in Medicine 24 (3): 137–146. January 2012. doi:10.3233/JRS-2012-0567. PMID 22936056. 
  90. "How CATIE brought us back to Kansas: a critical re-evaluation of the concept of atypical antipsychotics and their place in the treatment of schizophrenia". Advances in Psychiatric Treatment 14 (1): 17–28. 2008. doi:10.1192/apt.bp.107.003970. 
  91. "Typical and atypical antipsychotics--the misleading dichotomy. Results from the Working Group 'Drugs in Psychiatry' (AGATE)". Neuropsychobiology 57 (1–2): 80–87. 2008. doi:10.1159/000135641. PMID 18515977. 
  92. "Tardive dyskinesia and atypical antipsychotic drugs". Schizophrenia Research 35 (Suppl 1): S61–S66. March 1999. doi:10.1016/S0920-9964(98)00160-1. PMID 10190226. 
  93. "Biases in medication prescribing: the case of second-generation antipsychotics". Journal of Psychiatric Practice 16 (1): 15–21. January 2010. doi:10.1097/01.pra.0000367774.11260.e4. PMID 20098227. 
  94. 94.0 94.1 94.2 American Psychiatric Association (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Psychiatric Association),, retrieved 30 December 2013 , which cites
  95. 95.0 95.1 "Schizophrenia". BMJ Clin Evid 2012. June 2012. PMID 23870705. 
  96. "Dopamine supersensitivity psychosis in schizophrenia: Concepts and implications in clinical practice". Journal of Psychopharmacology 31 (12): 1511–1518. December 2017. doi:10.1177/0269881117728428. PMID 28925317. 
  97. "Neuroleptic Malignant Syndrome: Diagnosis and Management". The Primary Care Companion for CNS Disorders 20 (1). 4 January 2018. doi:10.4088/PCC.17r02185. PMID 29325237. 
  98. "Tardive dyskinesia risk with first- and second-generation antipsychotics in comparative randomized controlled trials: a meta-analysis". World Psychiatry 17 (3): 330–340. October 2018. doi:10.1002/wps.20579. PMID 30192088. 
  99. (in en) Textbook of Clinical Neuropsychiatry and Behavioral Neuroscience, Third Edition. CRC Press. 2012. p. 791. ISBN 9781444164947. 
  100. 100.0 100.1 "Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine". Therapeutic Advances in Drug Safety 9 (5): 237–256. May 2018. doi:10.1177/2042098618756261. PMID 29796248. 
  101. "Genetics of clozapine-associated neutropenia: recent advances, challenges and future perspective". Pharmacogenomics 20 (4): 279–290. March 2019. doi:10.2217/pgs-2018-0188. PMID 30767710. 
  102. "Cardiovascular disease in patients with schizophrenia". The Medical Journal of Australia 206 (2): 91–95. 6 February 2017. doi:10.5694/mja16.00650. PMID 28152356. 
  103. 103.0 103.1 "Clozapine-Associated Pulmonary Embolism: A High-Mortality, Dose-Independent and Early-Onset Adverse Effect". American Journal of Therapeutics 25 (4): e434–e438. August 2018. doi:10.1097/MJT.0000000000000806. PMID 29985823. 
  104. "Clozapine Associated Periorbital Edema in First Episode Psychosis: A Case Report of a Rare Adverse Effect in Treatment-Resistant Schizophrenia". Journal of Clinical Psychopharmacology 42 (6): 594–596. September 2022. doi:10.1097/JCP.0000000000001600. PMID 36066404. 
  105. "Guide to the Management of Clozapine-Related Tolerability and Safety Concerns". Clinical Schizophrenia & Related Psychoses 10 (3): 163–177. 2016. doi:10.3371/1935-1232.10.3.163. PMID 27732102. 
  106. "Pharmacogenetics of clozapine treatment response and side-effects in schizophrenia: an update". Expert Opinion on Drug Metabolism & Toxicology 11 (11): 1709–31. 2015. doi:10.1517/17425255.2015.1075003. PMID 26364648. 
  107. "Schizophrenia". BMJ 335 (7610): 91–5. July 2007. doi:10.1136/bmj.39227.616447.BE. PMID 17626963. 
  108. "The Role of Atypical Antipsychotics in Sexuality: Road to Recovery in Schizophrenia". Current Drug Targets 19 (12): 1402–1411. 2018. doi:10.2174/1389450118666170502130126. PMID 28464773. 
  109. "Adverse effects of antipsychotic medications". American Family Physician 81 (5): 617–22. March 2010. PMID 20187598. 
  110. "Managing anticholinergic side effects". Primary Care Companion to the Journal of Clinical Psychiatry 6 (Suppl 2): 20–3. 2004. PMID 16001097. 
  111. University of Hong Kong (September 6, 2022). "Antipsychotic Use Associated With Elevated Risk of Breast Cancer". 
  112. "Olanzapine-associated diabetes mellitus". Pharmacotherapy 22 (7): 841–52. July 2002. doi:10.1592/phco.22.11.841.33629. PMID 12126218. 
  113. "Sensitivity of the female rat to olanzapine-induced weight gain—far from the clinic?". Schizophrenia Research 116 (2–3): 299–300. February 2010. doi:10.1016/j.schres.2009.09.034. PMID 19840894. 
  114. 114.0 114.1 114.2 Goodman & Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York: McGraw-Hill. 2011. ISBN 978-0-07-162442-8. 
  115. "Alterations to melanocortinergic, GABAergic and cannabinoid neurotransmission associated with olanzapine-induced weight gain". PLOS ONE 7 (3): e33548. 2012. doi:10.1371/journal.pone.0033548. PMID 22438946. Bibcode2012PLoSO...733548W. 
  116. "Pancreatitis associated with atypical antipsychotics: from the Food and Drug Administration's MedWatch surveillance system and published reports". Pharmacotherapy 23 (9): 1123–30. September 2003. doi:10.1592/phco.23.10.1123.32759. PMID 14524644. 
  117. "Influence of antipsychotics on mortality in schizophrenia: systematic review". Schizophrenia Research 113 (1): 1–11. August 2009. doi:10.1016/j.schres.2009.05.018. PMID 19524406. 
  118. "Schizophrenia, neuroleptic medication and mortality". The British Journal of Psychiatry 188 (2): 122–7. February 2006. doi:10.1192/bjp.188.2.122. PMID 16449697. 
  119. American Geriatrics Society 2012 Beers Criteria Update Expert Panel (April 2012). "American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults". Journal of the American Geriatrics Society 60 (4): 616–31. doi:10.1111/j.1532-5415.2012.03923.x. PMID 22376048. 
  120. "Understanding and treating depersonalisation disorder". Advances in Psychiatric Treatment 11 (2): 92–100. 2005. doi:10.1192/apt.11.2.92. 
  121. "Antipsychotic polypharmacy: is there evidence for its use?". Journal of Psychiatric Practice 11 (4): 248–57. July 2005. doi:10.1097/00131746-200507000-00005. PMID 16041235. 
  122. "Polypharmacy and excessive dosing: psychiatrists' perceptions of antipsychotic drug prescription". The British Journal of Psychiatry 187 (3): 243–7. September 2005. doi:10.1192/bjp.187.3.243. PMID 16135861. 
  123. "Association of antipsychotic use with breast cancer: a systematic review and meta-analysis of observational studies with over 2 million individuals". Epidemiology and Psychiatric Sciences 31: e61. September 2022. doi:10.1017/S2045796022000476. PMID 36059215. 
  124. "Progressive loss of cortical gray matter in schizophrenia: a meta-analysis and meta-regression of longitudinal MRI studies". Translational Psychiatry 2 (11): e190. November 2012. doi:10.1038/tp.2012.116. PMID 23168990. 
  125. "Multimodal meta-analysis of structural and functional brain changes in first episode psychosis and the effects of antipsychotic medication". Neuroscience and Biobehavioral Reviews 36 (10): 2325–33. November 2012. doi:10.1016/j.neubiorev.2012.07.012. PMID 22910680. 
  126. "The influence of chronic exposure to antipsychotic medications on brain size before and after tissue fixation: a comparison of haloperidol and olanzapine in macaque monkeys". Neuropsychopharmacology 30 (9): 1649–1661. September 2005. doi:10.1038/sj.npp.1300710. PMID 15756305. 
  127. "Principles of antipsychotic prescribing for policy makers, circa 2008. Translating knowledge to promote individualized treatment". Schizophrenia Bulletin 35 (5): 931–936. September 2009. doi:10.1093/schbul/sbn019. PMID 18385207. 
  128. "The causes of underdiagnosing akathisia". Schizophrenia Bulletin 29 (3): 547–58. 2003. doi:10.1093/oxfordjournals.schbul.a007027. PMID 14609248. 
  129. "Influence of Antipsychotic and Anticholinergic Loads on Cognitive Functions in Patients with Schizophrenia". Schizophrenia Research and Treatment 2016: 8213165. 2016. doi:10.1155/2016/8213165. PMID 27144021. 
  130. "Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses". Therapeutic Advances in Chronic Disease 7 (5): 229–245. September 2016. doi:10.1177/2040622316658463. PMID 27583123. 
  131. "Antipsychotics, Metabolic Adverse Effects, and Cognitive Function in Schizophrenia". Frontiers in Psychiatry 9: 622. 2018-12-05. doi:10.3389/fpsyt.2018.00622. PMID 30568606. 
  132. "Antipsychotic use in dementia: the relationship between neuropsychiatric symptom profiles and adverse outcomes". European Journal of Epidemiology 36 (1): 89–101. January 2021. doi:10.1007/s10654-020-00643-2. PMID 32415541. 
  133. "Atypical antipsychotic use in patients with dementia: managing safety concerns". The American Journal of Psychiatry 169 (9): 900–906. September 2012. doi:10.1176/appi.ajp.2012.12030342. PMID 22952071. 
  134. Joint Formulary Committee, BMJ, ed (March 2009). "4.2.1". British National Formulary (57 ed.). United Kingdom: Royal Pharmaceutical Society of Great Britain. p. 192. ISBN 978-0-85369-845-6. "Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse." 
  135. 135.0 135.1 135.2 135.3 135.4 (in en) Adverse Syndromes and Psychiatric Drugs: A Clinical Guide. OUP Oxford. 2004. pp. 207–216. ISBN 9780198527480. 
  136. 136.0 136.1 "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse". Acta Psychiatrica Scandinavica 114 (1): 3–13. July 2006. doi:10.1111/j.1600-0447.2006.00787.x. PMID 16774655. 
  137. (in en) Adherence to Antipsychotics in Schizophrenia. Springer Science & Business Media. 2013. p. 85. ISBN 9788847026797. 
  138. "Dopamine supersensitivity psychosis in schizophrenia: Concepts and implications in clinical practice". Journal of Psychopharmacology 31 (12): 1511–1518. December 2017. doi:10.1177/0269881117728428. PMID 28925317. 
  139. "Expected incidence of tardive dyskinesia associated with atypical antipsychotics". The Journal of Clinical Psychiatry 61 (Suppl 4): 21–6. 2000. PMID 10739327. 
  140. "Switching antipsychotic therapy: what to expect and clinical strategies for improving therapeutic outcomes". The Journal of Clinical Psychiatry 68 (Suppl 6): 10–3. 2007. PMID 17650054. 
  141. BMJ Group (March 2009). "4.2.1". British National Formulary (57 ed.). United Kingdom: Royal Pharmaceutical Society of Great Britain. p. 192. "Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse." 
  142. "Up to 100,000 on antipsychotics with no review". Health Service Journal. 27 January 2020. 
  143. "Atypical Antipsychotics: Mechanism of Action". Focus 2 (1): 48–58. January 2004. doi:10.1176/foc.2.1.48. 
  144. "Caplyta (lumateperone) FDA Approval History" (in en). 
  145. 145.0 145.1 "Perospirone". CNS Drugs 15 (4): 329–37; discussion 338. 2001. doi:10.2165/00023210-200115040-00006. PMID 11463136. 
  146. "From clinical research to clinical practice: a 4-year review of ziprasidone". CNS Spectrums 10 (11 Suppl 17): 1–20. November 2005. doi:10.1017/S1092852900019842. PMID 16381088. 
  147. "Third generation antipsychotic drugs: partial agonism or receptor functional selectivity?". Current Pharmaceutical Design 16 (5): 488–501. 2010. doi:10.2174/138161210790361461. PMID 19909227. 
  148. "Aripiprazole: a review of its use in schizophrenia and schizoaffective disorder". Drugs 64 (15): 1715–36. 2004. doi:10.2165/00003495-200464150-00010. PMID 15257633. 
  149. "Neurochemical and Neural Mechanisms of Positive and Negative Symptoms in Schizophrenia". Modern Problems of Pharmacopsychiatry. Modern Trends in Pharmacopsychiatry 24: 124–151. 1990. doi:10.1159/000418015. ISBN 978-3-8055-5050-5. PMID 1970851. 
  150. "Antipsychotic medication and prefrontal cortex activation: a review of neuroimaging findings". European Neuropsychopharmacology 22 (6): 387–400. June 2012. doi:10.1016/j.euroneuro.2011.12.008. PMID 22300864. 
  151. 151.0 151.1 "The new genetics of schizophrenia". The Psychiatric Clinics of North America 26 (1): 41–63. March 2003. doi:10.1016/S0193-953X(02)00030-8. PMID 12683259. 
  152. "The role of 5-HT2A receptors in antipsychotic activity". Life Sciences 56 (25): 2209–22. 1995. doi:10.1016/0024-3205(95)00210-W. PMID 7791509. 
  153. "Evidences of possible side effects of neuroleptic drugs: A systematic review". Asian Pacific Journal of Reproduction 1 (4): 330–336. December 2012. doi:10.1016/s2305-0500(13)60105-0. ISSN 2305-0500. 
  154. 154.0 154.1 "Describing an Atypical Antipsychotic: Receptor Binding and Its Role in Pathophysiology". Primary Care Companion to the Journal of Clinical Psychiatry 5 (Suppl. 3): 9–13. 2003. 
  155. "Serotonergic Mechanisms as Targets for Existing and Novel Antipsychotics". Current Antipsychotics. Handbook of Experimental Pharmacology. 212. 2012. pp. 87–124. doi:10.1007/978-3-642-25761-2_4. ISBN 978-3-642-25760-5. 
  156. 156.00 156.01 156.02 156.03 156.04 156.05 156.06 156.07 156.08 156.09 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 156.34 156.35 156.36 156.37 156.38 156.39 156.40 156.41 156.42 156.43 156.44 156.45 Farmacología y endocrinología del comportamiento. Editorial UOC. May 2012. pp. 148–149. ISBN 978-84-9788-424-2. 
  157. Analogue-based Drug Discovery. John Wiley & Sons. 13 December 2006. pp. 305–. ISBN 978-3-527-60749-5. 
  158. 158.0 158.1 158.2 Neurotransmitter Receptors in Actions of Antipsychotic Medications. CRC Press. 22 June 2000. pp. 23–. ISBN 978-1-4200-4177-4. 
  159. 159.00 159.01 159.02 159.03 159.04 159.05 159.06 159.07 159.08 159.09 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 "Research on adverse drug events. I. Muscarinic M3 receptor binding affinity could predict the risk of antipsychotics to induce type 2 diabetes". Methods and Findings in Experimental and Clinical Pharmacology 27 (5): 289–304. June 2005. doi:10.1358/mf.2005.27.5.908643. PMID 16082416. 
  160. "Aripiprazole lauroxil – Alkermes – AdisInsight". 
  161. "Asenapine – AdisInsight". 
  162. "Blonanserin – Sumitomo Dainippon Pharma – AdisInsight". 
  163. "Brexpiprazole – Lundbeck/Otsuka – AdisInsight". 
  164. "Cariprazine – Gedeon Richter – AdisInsight". 
  165. 165.0 165.1 Antipsychotics. Springer Science & Business Media. 6 December 2012. pp. 360–. ISBN 978-3-642-61007-3. 
  166. William Andrew Publishing (22 October 2013). Pharmaceutical Manufacturing Encyclopedia. Elsevier. pp. 1077–. ISBN 978-0-8155-1856-3. 
  167. 167.0 167.1 William Andrew Publishing (22 October 2013). Pharmaceutical Manufacturing Encyclopedia. Elsevier. pp. 1102–. ISBN 978-0-8155-1856-3. 
  168. "ChemInform Abstract: Fifty Years in Chemical Drug Research". ChemInform 23 (9): no. 2010. doi:10.1002/chin.199209338. ISSN 0931-7597. 
  169. "[Clotepin]" (in cs). Časopis lékařů českých 110 (17): 404–5. April 1971. PMID 5576292. 
  170. 170.0 170.1 Drugs Available Abroad. Gale Research. 1991. p. 52,169. ISBN 978-0-8103-7177-4. 
  171. "Clotiapine compared with chlorpromazine in chronic schizophrenia". Schizophrenia Research 80 (2–3): 343–7. December 2005. doi:10.1016/j.schres.2005.07.007. PMID 16126373. 
  172. "Preclinical and clinical pharmacology of cyamemazine: anxiolytic effects and prevention of alcohol and benzodiazepine withdrawal syndrome". CNS Drug Reviews 10 (3): 219–29. 2004. doi:10.1111/j.1527-3458.2004.tb00023.x. PMID 15492772. 
  173. Bioactive Heterocyclic Compound Classes: Pharmaceuticals. John Wiley & Sons. 16 August 2012. pp. 3–. ISBN 978-3-527-66447-4. 
  174. 174.0 174.1 "Thioxanthene antipsychotics". European Psychiatry 11: 236s. 1996. doi:10.1016/0924-9338(96)88706-2. ISSN 0924-9338. 
  175. "Iloperidone – Vanda Pharmaceuticals – AdisInsight". 
  176. 176.0 176.1 Before Prozac: The Troubled History of Mood Disorders in Psychiatry. Oxford University Press, USA. 2009. pp. 14–. ISBN 978-0-19-536874-1. 
  177. "Does loxapine have "atypical" properties? Clinical evidence". The Journal of Clinical Psychiatry 60 (Suppl 10): 42–6. 1999. PMID 10340686. 
  178. "Lurasidone - Sumitomo Dainippon Pharma – AdisInsight". 
  179. "Nemonapride – AdisInsight". 
  180. "Paliperidone – Johnson & Johnson – AdisInsight". 
  181. "Paliperidone palmitate – Johnson & Johnson – AdisInsight". 
  182. 182.0 182.1 Piperidine-Based Drug Discovery. Elsevier Science. 12 June 2017. pp. 158, 195–. ISBN 978-0-12-813428-3. 
  183. "Penfluridol (R 16341) as a maintenance therapy in chronic psychotic patients: a double-blind clinical evaluation". Acta Psychiatrica Scandinavica 50 (2): 219–24. 1974. doi:10.1111/j.1600-0447.1974.tb08210.x. PMID 4604881. 
  184. "Perazine for schizophrenia". The Cochrane Database of Systematic Reviews (1): CD002832. Jan 2014. doi:10.1002/14651858.CD002832.pub3. PMID 24425538. 
  185. "Pericyazine for schizophrenia". The Cochrane Database of Systematic Reviews (5): CD007479. May 2014. doi:10.1002/14651858.CD007479.pub2. PMID 24825770. 
  186. "Perospirone – AdisInsight". 
  187. "Pimavanserin – ACADIA Pharmaceuticals – AdisInsight". 
  188. William Andrew Publishing (22 October 2013). Pharmaceutical Manufacturing Encyclopedia. Elsevier. pp. 2935–. ISBN 978-0-8155-1856-3. 
  189. William Andrew Publishing (2007). Pharmaceutical Manufacturing Encyclopedia. William Andrew Pub.. p. 3059. ISBN 978-0-8155-1526-5. 
  190. William Andrew Publishing (22 October 2013). Pharmaceutical Manufacturing Encyclopedia. Elsevier. pp. 3129–. ISBN 978-0-8155-1856-3. 
  191. William Andrew Publishing (22 October 2013). Pharmaceutical Manufacturing Encyclopedia. Elsevier. pp. 3214–. ISBN 978-0-8155-1856-3. 
  192. Rossi, S, ed (2013). Australian Medicines Handbook (2013 ed.). Adelaide: The Australian Medicines Handbook Unit Trust. ISBN 978-0-9805790-9-3. 
  193. Joint Formulary Committee (2013). British National Formulary (BNF) (65 ed.). London, UK: Pharmaceutical Press. ISBN 978-0-85711-084-8. 
  194. "Amisulpride overdose is frequently associated with QT prolongation and torsades de pointes". Journal of Clinical Psychopharmacology 30 (4): 391–5. August 2010. doi:10.1097/JCP.0b013e3181e5c14c. PMID 20531221. 
  195. 195.0 195.1 195.2 "Blonanserin: a review of its use in the management of schizophrenia". CNS Drugs 24 (1): 65–84. January 2010. doi:10.2165/11202620-000000000-00000. PMID 20030420. 
  196. 196.0 196.1 "Profile of blonanserin for the treatment of schizophrenia". Neuropsychiatric Disease and Treatment 9: 587–94. 2013. doi:10.2147/NDT.S34433. PMID 23766647. 
  197. "Clozapine". Martindale: The Complete Drug Reference. Royal Pharmaceutical Society of Great Britain. 30 January 2013. 
  198. "Fluphenazine (oral) versus placebo for schizophrenia". The Cochrane Database of Systematic Reviews 2020 (7): CD006352. June 2018. doi:10.1002/14651858.CD006352.pub3. PMID 29893410. 
  199. "Loxapine for schizophrenia". The Cochrane Database of Systematic Reviews 2007 (4): CD001943. October 2007. doi:10.1002/14651858.CD001943.pub2. PMID 17943763. 
  200. "Performance and interview-based assessments of cognitive change in a randomized, double-blind comparison of lurasidone vs. ziprasidone". Schizophrenia Research 127 (1–3): 188–94. April 2011. doi:10.1016/j.schres.2011.01.004. PMID 21277745. 
  201. "Auditing clinical outcomes after introducing off-licence prescribing of atypical antipsychotic melperone for patients with treatment refractory schizophrenia". TheScientificWorldJournal 2012: 1–5. 2012. doi:10.1100/2012/512047. PMID 22566771. 
  202. 202.0 202.1 Molindone Hydrochloride. The Royal Pharmaceutical Society of Great Britain. 30 January 2013. Retrieved 5 November 2013. 
  203. "Perazine for schizophrenia". The Cochrane Database of Systematic Reviews (1): CD002832. January 2014. doi:10.1002/14651858.CD002832.pub3. PMID 24425538. 
  204. "Perospirone". CNS Drugs 15 (4): 329–37; discussion 338. April 2001. doi:10.2165/00023210-200115040-00006. PMID 11463136. 
  205. 205.0 205.1 Perospirone. London, UK: Pharmaceutical Press. 23 September 2011. Retrieved 3 November 2013. 
  206. "Perphenazine for schizophrenia". The Cochrane Database of Systematic Reviews 2015 (3): CD003443. March 2015. doi:10.1002/14651858.CD003443.pub3. PMID 25749632. 
  207. "Pimozide for schizophrenia or related psychoses". The Cochrane Database of Systematic Reviews (11): CD001949. November 2013. doi:10.1002/14651858.CD001949.pub3. PMID 24194433. 
  208. "Sulpiride versus placebo for schizophrenia". The Cochrane Database of Systematic Reviews (4): CD007811. April 2014. doi:10.1002/14651858.CD007811.pub2. PMID 24729184. 
  209. "Thioridazine for schizophrenia". The Cochrane Database of Systematic Reviews 2007 (3): CD001944. July 2007. doi:10.1002/14651858.CD001944.pub2. PMID 17636691. 
  210. "Pathogenesis of degenerative retinopathies induced by thioridazine and other antipsychotics: a dopamine hypothesis". Documenta Ophthalmologica. Advances in Ophthalmology 105 (1): 41–9. July 2002. doi:10.1023/A:1015768114192. PMID 12152801. 
  211. "Trifluoperazine for schizophrenia". The Cochrane Database of Systematic Reviews 2004 (1): CD003545. 2004. doi:10.1002/14651858.CD003545.pub2. PMID 14974020. 
  212. "Zotepine". Martindale: The Complete Drug Reference. Royal Pharmaceutical Society of Great Britain. 16 August 2013. 
  213. "Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis". Lancet 378 (9799): 1306–1315. October 2011. doi:10.1016/S0140-6736(11)60873-8. PMID 21851976. 
  214. "Addressing the need for rapid treatment of agitation in schizophrenia and bipolar disorder: focus on inhaled loxapine as an alternative to injectable agents". Therapeutics and Clinical Risk Management 9: 235–245. 2013. doi:10.2147/TCRM.S31484. PMID 23723707. 
  215. "Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis". The International Journal of Neuropsychopharmacology 13 (1): 5–14. February 2010. doi:10.1017/S1461145709990344. PMID 19638254. 
  216. "Polarity index of pharmacological agents used for maintenance treatment of bipolar disorder". European Neuropsychopharmacology 22 (5): 339–346. May 2012. doi:10.1016/j.euroneuro.2011.09.008. PMID 22000157. 
  217. "Effectiveness of psychotropic medications in the maintenance phase of bipolar disorder: a meta-analysis of randomized controlled trials". The International Journal of Neuropsychopharmacology 14 (8): 1029–1049. September 2011. doi:10.1017/S1461145711000885. PMID 21733231. 
  218. "Second-generation antipsychotics for major depressive disorder and dysthymia". The Cochrane Database of Systematic Reviews (12): CD008121. December 2010. doi:10.1002/14651858.CD008121.pub2. PMID 21154393. 
  219. "Clozapine Can Be the Good Option in Resistant Mania". Case Reports in Psychiatry 2016: 3081704. 2016. doi:10.1155/2016/3081704. PMID 27525148. 
  220. "Clozapine As Transformative Treatment In Bipolar Patients". Neuropsychiatric Disease and Treatment 15: 2901–2905. 9 October 2019. doi:10.2147/NDT.S227196. PMID 31632038. 
  222. "Efficacy and tolerability of perospirone in schizophrenia: a systematic review and meta-analysis of randomized controlled trials". CNS Drugs 27 (9): 731–41. September 2013. doi:10.1007/s40263-013-0085-7. PMID 23812802. 
  223. "PDSP Ki Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. 12 January 2011. 
  224. "Asenapine: a novel psychopharmacologic agent with a unique human receptor signature". Journal of Psychopharmacology 23 (1): 65–73. January 2009. doi:10.1177/0269881107082944. PMID 18308814. 
  225. 225.0 225.1 "Lurasidone (SM-13496), a novel atypical antipsychotic drug, reverses MK-801-induced impairment of learning and memory in the rat passive-avoidance test". European Journal of Pharmacology 572 (2–3): 160–70. October 2007. doi:10.1016/j.ejphar.2007.06.058. PMID 17662268. 
  226. "Pharmacological profile of lurasidone, a novel antipsychotic agent with potent 5-hydroxytryptamine 7 (5-HT7) and 5-HT1A receptor activity". The Journal of Pharmacology and Experimental Therapeutics 334 (1): 171–81. July 2010. doi:10.1124/jpet.110.167346. PMID 20404009. 
  227. "Active metabolites as antidepressant drugs: the role of norquetiapine in the mechanism of action of quetiapine in the treatment of mood disorders". Frontiers in Psychiatry 4: 102. September 2013. doi:10.3389/fpsyt.2013.00102. PMID 24062697. 
  228. "Medscape home page". WebMD. 
  229. "Therapeutic Goods Administration home page". Therapeutic Goods Administration. Department of Health (Australia). 
  230. "Daily Med home page". Daily Med. United States National Library of Medicine. 
  231. "electronic Medicines Compendium (eMC) home page". electronic Medicines Compendium. Datapharm. 
  232. "Population pharmacokinetics of blonanserin in Chinese healthy volunteers and the effect of the food intake". Human Psychopharmacology 28 (2): 134–41. March 2013. doi:10.1002/hup.2290. PMID 23417765. 
  233. "Pharmacokinetics of parenteral and oral melperone in man". European Journal of Clinical Pharmacology 23 (2): 173–6. 1982. doi:10.1007/BF00545974. PMID 7140807. 
  234. "Olanzapine. Pharmacokinetic and pharmacodynamic profile". Clinical Pharmacokinetics 37 (3): 177–93. September 1999. doi:10.2165/00003088-199937030-00001. PMID 10511917. 
  235. "Absorption, metabolism, and excretion of paliperidone, a new monoaminergic antagonist, in humans". Drug Metabolism and Disposition 36 (4): 769–79. April 2008. doi:10.1124/dmd.107.018275. PMID 18227146. 
  236. "Clinical pharmacokinetics of quetiapine: an atypical antipsychotic". Clinical Pharmacokinetics 40 (7): 509–22. 2001. doi:10.2165/00003088-200140070-00003. PMID 11510628. 
  237. "The pharmacokinetics of intravenous and oral sulpiride in healthy human subjects". European Journal of Clinical Pharmacology 17 (5): 385–91. May 1980. doi:10.1007/BF00558453. PMID 7418717. 
  238. "Zotepine: A Review of its Pharmacodynamic and Pharmacokinetic Properties and Therapeutic Efficacy in the Management of Schizophrenia". CNS Drugs 9 (2): 153–175. January 1998. doi:10.2165/00023210-199809020-00006. 
  239. Product Information: Nipolept(R), zotepine. Klinge Pharma GmbH, Munich, 1996.
  240. The text reads: "When the patient lashes out against 'them' – THORAZINE (brand of chlorpromazine) quickly puts an end to his violent outburst. 'Thorazine' is especially effective when the psychotic episode is triggered by delusions or hallucinations. At the outset of treatment, Thorazine's combination of antipsychotic and sedative effects provides both emotional and physical calming. Assaultive or destructive behavior is rapidly controlled. As therapy continues, the initial sedative effect gradually disappears. But the antipsychotic effect continues, helping to dispel or modify delusions, hallucinations and confusion, while keeping the patient calm and approachable. SMITH KLINE AND FRENCH LABORATORIES leaders in psychopharmaceutical research."
  241. 241.0 241.1 "The introduction of chlorpromazine in Belgium and the Netherlands (1951-1968); tango between old and new treatment features". Studies in History and Philosophy of Biological and Biomedical Sciences 42 (4): 443–452. December 2011. doi:10.1016/j.shpsc.2011.05.003. PMID 22035718. 
  242. Psychiatric Drugs Explained. (4th ed.). Britain: Elsevier Limited. 2005. pp. 8, 17. 
  243. "tranquillizer, n". Oxford English Dictionary. 1989. 
  244. "The intersection of psychopharmacology and psychiatry in the second half of the twentieth century". History of Psychiatry and Medical Psychology. Boston, MA: Springer US. 2008. p. 421. doi:10.1007/978-0-387-34708-0_13. ISBN 978-0-387-34707-3. 
  245. A guide to the extrapyramidal side-effects of antipsychotic drugs. Cambridge University Press. 13 April 1999. p. 12. ISBN 978-0-521-63353-6. 
  246. "British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update". Journal of Psychopharmacology 33 (8): 923–947. August 2019. doi:10.1177/0269881119855343. PMID 31271339. 
  247. Psychiatry Volume 2. Saunders. 1997. p. 956. ISBN 978-0-7216-5257-3. 
  248. "neuroleptic" (in en). Lexicon of Psychiatry, Neurology, and the Neurosciences. Lippincott Williams & Wilkins. 2000. p. 675. ISBN 9780781724685. 
  249. R. Elliott Ingersoll, Carl F. Rak (2015): Psychopharmacology for Mental Health Professionals: An Integrative Approach, Cengage Learning, Boston, pp. 150-186 and 342-349, ISBN:9781305537231.
  250. (in en) Manual of Psychiatric Nursing Skills. Jones & Bartlett Publishers. 2011. p. 317. ISBN 9781449613563. 
  251. (in en) Drug Policy and the Public Good. OUP Oxford. 2010. p. 329. ISBN 9780199557127. 
  252. 252.0 252.1 Pipelineantipsychotic drugs to drive next market evolution (2009). (7 August 2009).
  253. "Antipsychotic use and expenditure in the United States". Psychiatric Services 57 (12): 1693. December 2006. doi:10.1176/ PMID 17158480. 
  254. 2008 U.S. Sales and Prescription Information: Top Therapeutic Classes by U.S. Sales (PDF) .
  255. "Data show 'spiralling' antipsychotic price increases of up to 1,200% in past five years". Pharmaceutical Journal. 24 August 2022. 
  256. "Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units". BMC Pharmacology & Toxicology 14 (1): 10. February 2013. doi:10.1186/2050-6511-14-10. PMID 23391323. 
  257. Risky Antipsychotic Drugs Still Overprescribed In Nursing Homes,
  258. Atypical antipsychotics: overrated and overprescribed, Glen Spielsman,
  259. "Transdermal Asenapine in Schizophrenia: A Systematic Review". Patient Preference and Adherence 14: 1541–1551. 18 March 2020. doi:10.2147/PPA.S235104. PMID 32943849. 
  260. 260.0 260.1 260.2 260.3 260.4 "Abuse of second-generation antipsychotics: What prescribers need to know". Current Psychiatry 10 (5): 77–79. 2011. 
  261. "Myth of the antipsychotic". The Guardian. 2 March 2008. 
  262. "GPs under 'pressure' to issue neuroleptics, claims professor". 
  263. "Dementia drug use 'killing many'". 12 November 2009. 
  264. "UK study warns against anti-psychotics for dementia". Reuters. 12 November 2009. 
  265. "Justice suit accuses Johnson & Johnson of paying kickbacks". The Washington Post. 16 January 2010. 
  266. 266.0 266.1 266.2 "Side Effects May Include Lawsuits". The New York Times. 2 October 2010. 
  267. "Drug Maker's E-Mail Released in Seroquel Lawsuit". The New York Times. 27 February 2009. 
  268. "Pharmaceutical industry agenda setting in mental health policies". Ethical Human Sciences and Services 3 (3): 147–159. 1 January 2001. doi:10.1891/1523-150X.3.3.147. PMID 15278977. 
  269. 269.0 269.1 269.2 American Psychiatric Association (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Psychiatric Association),, retrieved 30 December 2013 , which cites
  270. American Geriatrics Society, "Ten Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Geriatrics Society),, retrieved 1 August 2013 , which cites

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