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Medications for Psychosis: Dopamine Blockers and Dopamine Partial Agonists (Antipsychotics)

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Tasman’s Psychiatry

Abstract

Since the era of antipsychotic pharmacotherapy began with the discovery of the antipsychotic properties of chlorpromazine in 1952, many new medications for psychosis (antipsychotics) have become available. All currently approved medications for psychosis, except pimavanserin, remain dopaminergic agents. Medications for psychosis alleviate psychotic symptoms and prevent relapse into psychosis in the treatment of schizophrenia. Moreover, they are also indicated for a variety of other conditions, including bipolar disorder and treatment-resistant depression. Medications for psychosis sometimes cause various side effects while their side effect profiles greatly differ among individual drugs. Much effort has recently been devoted to developing drugs that exert their effects by modulating neural systems other than the dopaminergic system, and several drugs have demonstrated promising results in Phase II and III trials. In addition, individualized treatment for a specific patient based on their biological characteristics is one of the future goals of psychopharmacological treatment of schizophrenia. These goals will be achieved with precise biological characterization of this illness.

This chapter is an update from the 4th edition. Previous edition authors were Seiya Miyamoto, David B. Merrill, L. Fredrik Jarskog, W. Wolfgang Fleishhacker, Stephen R. Marder and Jeffrey A. Lieberman

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Conflict of Interest Statements

Dr. Uchida has received grants from Eisai, Otsuka Pharmaceutical, Dainippon-Sumitomo Pharma, and Meiji-Seika Pharma; speaker’s honoraria from Otsuka Pharmaceutical, Dainippon-Sumitomo Pharma, Eisai, and Meiji-Seika Pharma; and advisory panel payments from Dainippon-Sumitomo Pharma within the past 3 years.

Dr. Euitae Kim has received grants from Otsuka and participated in advisory/speaker meetings organized by Janssen, Otsuka, and Bukwang Pharm Company.

Dr. Jarskog has received grant support from Boeringer Ingelheim, Otsuka, and Corcept, and has consulted for Signant Health and UpToDate within the past 3 years.

Dr. Fleischhacker has received research grants from Lundbeck and Otsuka. He has received honoraria for educational programs from Janssen, Richter, and Recordati, and advisory board honoraria from Angelini, Otsuka, Boehringer-Ingelheim, and Dainippon/Sumitomo.

Dr. Remington has received research and advisory board support from HLS Therapeutics, as well as consultant fees from Mitsubishi Tanabe Pharma Corporation.

Dr. Lieberman neither accepts nor receives any personal financial remuneration for consulting, speaking, or research activities from any pharmaceutical, biotechnology, or medical device companies. He receives support administered through Columbia University and the Research Foundation for Mental Hygiene in the form of funding and medication supplies for investigator initiated research from Denovo, Taisho, Sunovion, and Genentech, and for company sponsored Phase II, III, and IV studies from Alkermes, Allergan, and Boehringer Ingelheim. However, none of this research support contributes to his institutional compensation. He is a consultant to or member of the advisory board of Intracellular Therapies, Lilly, Pierre Fabre, Pear Therapeutics, and Gilgamesh Therapeutics for which he receives no remuneration. He is a paid consultant for Signant, a clinical research services organization, and holds a patent from Repligen that neither has nor currently yields any royalties.

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Uchida, H., Kim, E., Jarskog, L.F., Fleischhacker, W.W., Remington, G., Lieberman, J.A. (2023). Medications for Psychosis: Dopamine Blockers and Dopamine Partial Agonists (Antipsychotics). In: Tasman, A., et al. Tasman’s Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-42825-9_134-1

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