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Antipsychotics

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Critical Care Toxicology

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Abstract

The discovery of chlorpromazine and other traditional antipsychotic agents in the early 1950s revolutionized the management of schizophrenia and led to a dramatic reduction in the number of hospitalizations necessary for patients with psychosis. Shortly after their introduction, however, it was noted that these agents often produced disabling neurological side effects (e.g., sedation, extrapyramidal side effects [EPS], tardive dyskinesia [TD]) and were ineffective against the negative symptoms (e.g., anhedonia, apathy, inactivity, poverty of thought, social withdrawal) and neurocognitive deficits of schizophrenia. Initially, it was thought that EPS were linked inextricably to antipsychotic drug action. The introduction of clozapine in 1990 and other so-called atypical agents shortly thereafter has further revolutionized the management of schizophrenia. Compared with traditional antipsychotics, atypical agents produce minimal EPS at clinically effective antipsychotic doses and seem to be more effective for the negative symptoms and neurocognitive deficits of schizophrenia. This chapter describes in detail the pharmacology and toxicology of traditional and atypical antipsychotic agents.

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Author information

Authors and Affiliations

  1. Harvard Medical Toxicology Fellow, Children’s Hospital, Boston, MA, USA

    Bradley L. Demeter

  2. Division of Toxicology, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Michael J. Burns

Authors
  1. Bradley L. Demeter
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  2. Michael J. Burns
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Corresponding author

Correspondence to Bradley L. Demeter .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I.

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1.

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2.

    Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

  4. II-3.

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III.

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Demeter, B.L., Burns, M.J. (2016). Antipsychotics. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_71-2

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  • DOI: https://doi.org/10.1007/978-3-319-20790-2_71-2

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  1. Latest

    Antipsychotics
    Published:
    18 October 2016

    DOI: https://doi.org/10.1007/978-3-319-20790-2_71-2

  2. Original

    Antipsychotics
    Published:
    10 September 2015

    DOI: https://doi.org/10.1007/978-3-319-20790-2_71-1

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