Second Generation Antipsychotic (A Comprehensive Guide)

Second Generation Antipsychotic

Second generation antipsychotic drugs are commonly known as atypical antipsychotics (AAP).

Second generation antipsychotic drugs include various medications that are commonly used to treat psychiatric disorders such as tranquilizers and neuroleptics.

Second generation antipsychotic make to known afterward 1970s although some of the Second generation antipsychotic are free from any sanctions on the base of approval from a number of countries to deal with various psychiatric disorders such as schizophrenia, mood disorder, autism spectrum disorder, also serve as a supporter in major depressive disorder.

Second generation antipsychotic have a tendency to bind at the receptor sides in dopamine pathways to the brain.

First generation antipsychotic serve as the reason to lose the motor control movements in individual with some disorder such as Parkinson disease abnormal movements, body rigidity and involuntary trembles that’s why only few Second generation antipsychotic consider to be used as compare to first generation antipsychotic that have less influence.

In this article we will discuss second generation antipsychotics. 

Second Generation Antipsychotic (A Comprehensive Guide)

Various studies have investigated the efficacy of mostly prescribed Second generation antipsychotic as compared to first generation antipsychotic.

Although both have some benefits and side-effects at the same time.

But second generation antipsychotic usually consider as the safe one because typical antipsychotic have some serious side effects such as movement disorder, neuroleptic malignant syndrome, increased the chances of stroke, cardiac problem i.e. abrupt death of cardiac system, increased rate of blood clots and diabetes expect that sudden change in the body weight can also be observed.

Some opponents also suggest that the use of both first and Second generation antipsychotic should be abandoned. 

Medical uses of Second generation antipsychotic

Second generation antipsychotic drugs are used to treat a number of psychiatric disorders such as schizophrenia and mood disorder.

Some psychiatric disorders such as dementia, anxiety disorder, autism and obsessive compulsive disorder have the symptom of agitation or nervousness in that case second generation antipsychotic is considered the best way to deal with such symptoms.

In the case of dementia Second generation antipsychotic can only be used in two conditions that are described below

·         If various other treatment fail to improve the person’s condition

·         If a patient is considered as a treat for themselves and the surroundings.

Treating Schizophrenia with Second generation antipsychotic

Schizophrenia is known as having the positive (hallucination, delusion) and negative (disorganized speech, flat affect, functional disturbance) symptoms that’s why antipsychotic medication is considered the best way to deal with the positive symptoms at first.

Because antipsychotic drugs have a tendency to decrease the intensity of positive symptoms in just 8-15 days.

But in case of negative symptoms antipsychotics is not a good option because it can only deal with secondary negative symptoms of the disorder for a shorter duration whereas antipsychotic becomes the main cause of deterioration for the negative symptoms of schizophrenia.

Moreover, Second generation antipsychotic are failed to provide any systematic success in order to prove its benefits for the negative symptoms of schizophrenia also very little evidence about the long-term use of Second generation antipsychotic and its effects on schizophrenia.

In the case of making a decision related to choosing the Second generation antipsychotic for a patient depends on the success rate, threats and expenses of medication.

Although, it is difficult to determine whether the first or second generation antipsychotic have better effect on patients because both antipsychotic have various benefits and risk from low to moderate quantity such as in some cases it is evident that 40-50% patients shows improvements in their symptoms due to the use of antipsychotic, almost 30-40 % patients with schizophrenia shows a limited response toward the antipsychotic medication.

The remaining 20% shows the conflicting response which means after receiving the different type of antipsychotic medication for at least 1 and half month the severity of symptoms don’t show any improvement. 

Effectiveness of Second generation antipsychotic while dealing with schizophrenia

First generation antipsychotic and second generation antipsychotic have been challenged on the basis of their efficacy while dealing with schizophrenia.

First generation antipsychotic drugs are effective in meeting the patient’s need for drugs. Second generation antipsychotics have the tendency to reduce the psychotic symptoms in a better way and also have lower side-effects (extrapyramidal) as compared to typical antipsychotic.

Although the above statement is challenged by various critiques. In 2005, a project named as “CATE” under the frame of US government (NIMH) the study shows a comparison between the Second generation antipsychotic and typical antipsychotic such as Perphenazine.

Second Generation Antipsychotic (A Comprehensive Guide)

 The project is free from the influence of pharmaceutical companies and based on double-blind study.

The sample was composed of 1493 patients suffering from schizophrenia.

The finding revealed on the basis of discontinuity level (stop taking medication when side-effects appear) that Olanzapine performs better as compared to Perphenazine and other drugs.

Other than that, Olanzapine also has a better effect in reducing the psychotic symptoms and the chances of being hospitalized.

But it also shows an apparently greater side effect on metabolic systems such as changes in the body weight of the patients (gain 9.4lbs in excess of 18 months), sudden increase was also associated with glucose, cholesterol and triglycerides rate of the patients with schizophrenia. 

A meta-analysis conducted by Leucht et al shows that any other Second generation antipsychotic did not produce the better effect as compared to Perphenazine based on the quantity of antipsychotic neither provide any worse side-effect from first generation antipsychotic.

The factor of compliance was consistent in both studies.

But these findings also question the rate of prescribing these medications and the difference between the both groups of antipsychotics.

 It is also claimed that the term “second-generation antipsychotic” has no power in general also the medications that are placed under this category have no similarity in terms of appliance, benefits and risks with each other.

Bipolar disorder

In case of bipolar or mood disorder, Second generation antipsychotic drugs are well-known to control the acute mania and mixed episode rapidly with the combination of mood stabilizers such as lithium and valproate that have the ability to overdue the inception of the disorder.

In case of dealing with the milder form of bipolar and mixed episode the first line prescription would be mood stabilizer Monotherapy.

Second generation antipsychotic drugs are also known as dealing with the other characteristics of various disorders such as in case of acute bipolar, mild form of depression it works as monotherapy that depends on medication.

Moreover, the antipsychotic also shows the apparent success rate in three different treatment levels of mood disorder such as, Quetiapine and Olanzapine.

Another antipsychotic known as Latuda shows some significant success rate in acute depressive episodes of bipolar disorder.

Major depressive disorder

Some Second generation antipsychotic drugs work as an adjunctive agent in demonstrating the success rate while dealing with the major depressive disorder without psychotic symptoms such as Aripirazole, Brexpiprazole, Olanzapine, Quetiapin and Ziprasidone. 

Whereas, some Second generation antipsychotic serve as a monotherapy in determining the efficacy rate while dealing with major depressive disorder without psychotic symptoms such as Quetiapine as compare to Fluoxetine that is consider effective while dealing with major depressive disorder including both psychotic and without psychotic symptoms.

According to the FDA in the united states of America some antipsychotics have been given the approval of use in the adjunct intervention of major depressive disorder such as Aripiprazole, Brexpiprazole, Olanzapine, Quetiapine.

While, some other antipsychotic get the permission to serve as monotherapies in the treatment of bipolar disorder such as Quetiapine and Lurasidone.

But, in case of the present situation Lurasidone didn’t get the approval to be used while dealing with major depressive disorder.

Autism

Some Second generation antipsychotic medications have been able to receive the approval to be used as an effective medication while dealing with the autism spectrum disorder such as the antipsychotic known as Risperidone and Aripiprazole.

Second Generation Antipsychotic (A Comprehensive Guide)

Dementia and Alzheimer’s disease

The record from May 2007 to April 2008 shows that patients suffering from Dementia and Alzheimer disease aged 65 or older received the prescription and also took 28% second generation antipsychotic drugs.

The nutrition and medication supervision in the united states of America suggest that all second generation antipsychotic drug must labelled with the caution that the medication is directly linked with the apparently higher risk of mortality rate especially in the people of older age people and the caution is written in the black box that must be carried by all the second generation antipsychotic.

The food and drug administration in the United States of America in 2005, also released a caution for their people about the higher rate of death in elderly who use second generation antipsychotic in order to deal with dementia.

After the suggestion by the government a rapid decrease in the production and usage of second generation antipsychotic drugs have been viewed at least 50% in the following five years

Adverse side-effects of the second generation of antipsychotic while dealing with psychiatric disorders.

Second generation antipsychotics have a tendency to lower the chances of Tardive Dyskinesia as compared to first generation antipsychotic.

Tardive Dyskinesia commonly grows after the use of antipsychotic drugs for many years.

Some adverse side-effects also reported such as Second generation antipsychotic increased the threats for cardiovascular disease.

Sexual side-effects have also been viewed after taking the Second generation antipsychotic drugs.

Especially in males these antipsychotics lower the sexual interest, creating deficits in patients sexual performance.

In females antipsychotic causes the disruption in menstrual cycle and the rate of infertility.

However, male and female have some similar effect due to the antipsychotics such as the enlargement of breasts.

Second Generation Antipsychotic (A Comprehensive Guide)

FAQ about Second Generation Antipsychotics

What is a second generation drug?

Second generation antipsychotics emerged in the 1980s are commonly known as atypical antipsychotics (AAP).

Second generation antipsychotic drugs include various medications that are commonly used to treat psychiatric disorders such as tranquilizers and neuroleptics.

Second generation antipsychotic drugs are free from any sanctions on the basis of approval from a number of countries to deal with various psychiatric disorders such as schizophrenia, mood disorder, autism spectrum disorder, also serve as a supporter in major depressive disorder.

Is risperidone a second generation antipsychotic?

Second generation antipsychotic that are commonly known as atypical antipsychotics i.e. Risperidone.

The Second generation antipsychotic is famous in dealing with the positive symptoms of schizophrenia with the duration of 8-15 days.

But in case of negative symptoms antipsychotics is not a good option because it can only deal with secondary negative symptoms of the disorder for a shorter duration whereas antipsychotic becomes the main cause of deterioration for the negative symptoms of schizophrenia.

Are typical antipsychotics still used?

Typical antipsychotic are now known as the atypical antipsychotic.

First generation antipsychotic serve as the reason to lose the motor control movements in individual with some disorder such as Parkinson disease abnormal movements, body rigidity and involuntary trembles that’s why only few Second generation antipsychotic consider to be used as compare to first generation antipsychotic that have less influence.

Reference 

Encyclopedia.com: “Atypical antipsychotic (2020)”

Second Generation Antipsychotic (A Comprehensive Guide)

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behavior, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.