From Chlorpromazine to Clozapine-Antipsychotic Adverse Effects and the Clinician's Dilemma

被引:33
作者
Abidi, Sabina [2 ]
Bhaskara, Sreenivasa M. [1 ,2 ]
机构
[1] Bedford Sackville Mental Hlth, Lower Sackville, NS B4C 3P2, Canada
[2] Dalhousie Univ, Halifax, NS, Canada
来源
CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE | 2003年 / 48卷 / 11期
关键词
schizophrenia; atypical antipsychotics; typical antipsychotics; adverse effect; diabetes; obesity; dyslipidemias; cardiovascular risk;
D O I
10.1177/070674370304801107
中图分类号
R749 [精神病学];
学科分类号
100205 [精神病与精神卫生学];
摘要
The pharmacotherapy of schizophrenia remains an ongoing challenge for researchers and clinicians alike. Current medications remain suboptimal to effectively treat this illness despite the recent surge of what are considered to be better antipsychotics: the atypicals. The atypicals cause fewer extrapyramidal symptoms and tardive dyskinesia, but there is growing concern regarding the significant long-term metabolic and cardiac adverse effects of these novel antipsychotics. There are differences among the atypicals in their propensity to produce these adverse effects, and clinicians should weigh the risk-benefit ratio for each drug with each individual patient. Diabetes, heart disease, obesity, and unhealthy lifestyle choices are on the rise in the general population, and individuals with chronic schizophrenia are even more at risk. The dilemma clinicians face in trying to avoid the neurological morbidity of the typicals (extrapyramidal side effects and tardive dyskinesia) is the risk of consequently exposing patients to both the morbidity and potential mortality of the atypicals (cardiovascular, endocrine, and metabolic adverse effects). The importance of baseline investigations and monitoring at regular intervals as well as identification of patients at risk for obesity, diabetes, and cardiovascular morbidity has become crucial. Informed decision making is essential for successful antipsychotic pharmacotherapy. For a condition, which often necessitates long-term pharmacotherapy, the importance of prevention and (or) minimization of morbidity and mortality related to adverse effects of such pharmacotherapy cannot be understated.
引用
收藏
页码:749 / 755
页数:7
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