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Antipsychotics/Neuroleptics: Course and Duration of Therapy, Withdrawal Symptoms, Resistance to Therapy, Side Effects, and Contraindications

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NeuroPsychopharmacotherapy

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Abstract

The treatment of schizophrenia benefited from the serendipitous discovery that chlorpromazine could alleviate the positive symptoms of the disease. At a time when treatments for schizophrenia were far from ideal, this discovery heralded in a new era of pharmacotherapy for the disease. Chlorpromazine acts primarily by blocking dopamine D2 receptors. Along with other drugs that are mechanistically similar, these drugs are collectively known as first generation antipsychotics (FGAs) or neuroleptics. However, because of their lack of mechanistic specificity, FGAs are associated with several side effects, which are often serious. They also show no efficacy in treating the negative symptoms of schizophrenia. Consequently, many newer second-generation antipsychotics (SGAs) have since been developed, beginning with the development of clozapine. SGAs typically exert simultaneous D2 receptor antagonist and serotonin (5HT)-2A receptor antagonist effects. Although SGAs still have their own related side effects, they tend to be fewer and less detrimental than those associated with FGAs. Indeed, choosing the correct pharmacotherapy for an individual patient with schizophrenia is complex and requires consideration of many factors. Understanding the properties of these different classes of drugs is helpful for current treatment strategies and development of future antipsychotics.

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Authors and Affiliations

  1. Department of Neuropsychiatry, Unit of Translation Medicine Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Yoshiro Morimoto, Shinji Kanegae & Hiroki Ozawa

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  1. Yoshiro Morimoto
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  2. Shinji Kanegae
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  3. Hiroki Ozawa
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Correspondence to Hiroki Ozawa .

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Editors and Affiliations

  1. Dept Psychiatry , Psychosomatics & Psychotherapy, University of Würzburg, Medical School Clinical Neurochemistry, Würzburg, Germany

    Peter Riederer

  2. Inst für Psychologische Medizin, Haag, Bayern, Germany

    Gerd Laux

  3. Fujita Health University School Medicine, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Würzburg, Bayern, Germany

    Christian Riederer

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  1. Department of Psychiatry, University Hospital Leipzig, Leipzig, Germany

    Frank Schmidt

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Morimoto, Y., Kanegae, S., Ozawa, H. (2021). Antipsychotics/Neuroleptics: Course and Duration of Therapy, Withdrawal Symptoms, Resistance to Therapy, Side Effects, and Contraindications. In: Riederer, P., Laux, G., Nagatsu, T., Le, W., Riederer, C. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-56015-1_54-1

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