Skip to main content
Log in

Should the treatment of schizophrenia include old antipsychotic drugs?

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Clozapine, although not suitable as a first-line drug, is superior to all other antipsychotics in terms of minimizing positive symptoms, reducing side effects, and treating treatment-resistant patients. There is little evidence that other newer drugs share these benefits. For certain patients it is not difficult to justify, on clinical grounds, the additional cost of prescribing clozapine. The case for prescribing one of the other newer drugs in preference to a traditional antipsychotic is often less clear-cut. Traditional antipsychotics clearly still have a role in the treatment of schizophrenia and they remain the authors’ preferred choice of first-line therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. British Medical Association & Royal Pharmaceutical Society of Great Britain: British National Formulary 39. London: Pharmaceutical Press; 2000

    Google Scholar 

  2. Essali MA, Rezk E, Wahlbeck K, et al.: Clozapine v “typical” neuroleptic medication for schizophrenia. In The Cochrane Database of Systematic Reviews, issue 2. Oxford: The Cochrane Collaboration; 1997.

    Google Scholar 

  3. Kennedy E, Song F, Hunter R, et al.: Risperidone versus “conventional” antipsychotic medication for schizophrenia. In The Cochrane Database of Systematic Reviews, issue 2. Oxford: The Cochrane Collaboration; 1997.

    Google Scholar 

  4. Leucht S, Pitschel-Walz G, Abraham D & Kissling W: Efficacy and extrapyramidal side-effects of new antipsychotics olanzapine, quetiapine, risperidone and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomised controlled trials. Schizophr Res 1999, 35:51–68. Probably the most comprehensive and up-to-date review available.

    Article  PubMed  CAS  Google Scholar 

  5. Carpenter WT, Heinrichs DW, Alphs LD: Treatment of negative symptoms. Schizophr Bull 1985, 11:440–452.

    PubMed  Google Scholar 

  6. Rosenheck R, Dunn L, Peszke M, et al.: Impact of clozapine on negative symptoms and on the deficit syndrome in refractory schizophrenia. Am J Psychiatry 1999, 156:88–93.

    PubMed  CAS  Google Scholar 

  7. Farde L, Nordstrom AL, Halldin C, et al.: PET studies of dopamine receptors in relation to antipsychotic drug treatment. Clin Neuropharmacol 1992, 15(Suppl_1):468–469.

    Google Scholar 

  8. Miller CH, Mohr F, Umbricht et al.: The prevalence of acute extrapyramidal signs and symptoms in patients treated with clozapine, risperidone and conventional antipsychotics. J Clin Psychiatry 1998, 59:69–75. An interesting approach to assessing side effects in day-to-day clinical practice.

    PubMed  CAS  Google Scholar 

  9. Bondolphi G, Dufour H, Patris M, et al.: Risperidone versus clozapine in treatment-resistant chronic schizophrenia: a randomized double-blind study. Am J Psychiatry 1998, 155:499–504.

    Google Scholar 

  10. Medicine Control Agency, Committee on Safety of Medicines: Clozapine and gastro-intestinal obstruction. Curr Prob Pharmacovigilance 1999, 25:5.

    Google Scholar 

  11. Kane JM, Honigfeld G, Singer J, Meltzer HY: Clozapine and the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988, 45:789–796.

    PubMed  CAS  Google Scholar 

  12. Buchanan RW, Breier A, Kirkpatrick B, et al.: Positive and negative symptom response to clozapine in schizophrenic patients with and without the deficit syndrome. Am J Psychiatry 1998, 155:751–760.

    PubMed  CAS  Google Scholar 

  13. Conley RR, Tamminga CA, Bartko JJ, et al.: Olanzapine compared with chlorpromazine in treatment-resistant schizophrenia. Am J Psychiatry 1998, 155:914–920.

    PubMed  CAS  Google Scholar 

  14. Breier A, Hamilton SH: Comparative efficacy of olanzapine and haloperidol for patients with treatment resistant schizophrenia. Biol Psychiatry 1999, 45:403–411.

    Article  PubMed  CAS  Google Scholar 

  15. Marder SR: Newer antipsychotics in treatment-resistant schizophrenia [editorial]. Biol Psychiatry 1999, 45:383–384.

    Article  PubMed  CAS  Google Scholar 

  16. Mahmoud R, Engelhart L, Ollendorf D, et al.: The risperidone outcomes study of effectiveness (ROSE): a model for evaluating treatment strategies in typical psychiatric practice. J Clin Psychiatry 1999, 60:42–47.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steel, R.M., Johnstone, E.C. Should the treatment of schizophrenia include old antipsychotic drugs?. Curr Psychiatry Rep 2, 404–409 (2000). https://doi.org/10.1007/s11920-000-0023-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-000-0023-5

Keywords

Navigation