Antipsychotics

First Generation ◽

Black Box ◽

Brand Names ◽

Clinical Use ◽

Childbearing Age ◽

Medical Disorders ◽

Second Generation Antipsychotics ◽

Black Box Warnings ◽

Potential Risks

The chapter on antipsychotics discusses and reviews the use of first-generation antipsychotics, including haloperidol and chlorpromazine, as well as the use of second-generation antipsychotics, including risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, clozapine, paliperidone, iloperidone, asenapine, lurasidone, brexpiprazole, and cariprazine. Pimavanserin is also discussed. The chapter reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, and potential risks including neuroleptic side effects such as acute dystonias, parkinsonian symptoms, akathisia, and tardive dyskinesia. Metabolic syndrome (which includes risks of weight gain, hyperglycemia, and hyperlipidemias) and cardiac risks are also discussed. The chapter also briefly discusses complementary and alternative pharmacotherapies. It then provides an in-depth review of the clinical use of antipsychotics for psychotic and behavioral disorders, as well as for other nonpsychotic psychiatric and medical disorders. It also discusses the use of antipsychotics in women of childbearing age, notably in regard to pregnancy and breastfeeding considerations. Finally, the chapter includes a table of antipsychotics that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications.

Stimulants and Other ADHD Medicines

Psychopharmacology ◽

10.1093/med/9780197537046.003.0006 ◽

2020 ◽

pp. 231-266

Author(s):

Arash Ansari ◽

David N. Osser

Keyword(s):

Eating Disorder ◽

Mechanisms Of Action ◽

Black Box ◽

Brand Names ◽

Clinical Use ◽

Childbearing Age ◽

Hyperactivity Disorder ◽

Medical Disorders ◽

The chapter on adult attention-deficit/hyperactivity disorder (ADHD) medicines discusses and reviews the use of psychostimulants (such as methylphenidate and amphetamines), and nonstimulants (such as atomoxetine, guanfacine, and clonidine). It reviews their mechanisms of action, clinical characteristics, potential medication interactions, and adverse effects. It further reviews stimulants’ risk of misuse and dependence. The chapter also briefly discusses complementary and alternative pharmacotherapies. It includes an in-depth review of the clinical use of these medications for ADHD (particularly in college students) and for other psychiatric disorders (such as binge-eating disorder) and other medical disorders. It also discusses the use of ADHD medicines in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of ADHD medicines that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications.

Mood Stabilizers

Psychopharmacology ◽

10.1093/med/9780197537046.003.0005 ◽

2020 ◽

pp. 185-230

Author(s):

Arash Ansari ◽

David N. Osser

Keyword(s):

Bipolar Depression ◽

Black Box ◽

Brand Names ◽

Mood Stabilizers ◽

Clinical Use ◽

Omega 3 ◽

Childbearing Age ◽

Second Generation Antipsychotics ◽

The chapter on mood stabilizers discusses and reviews the use of available treatments for bipolar disorder, including lithium, selected anticonvulsants (such as valproate, carbamazepine, oxcarbazepine, and lamotrigine) and second-generation antipsychotics. It reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, and adverse effects. The chapter also reviews emerging pharmacotherapies such as the use of ketamine. It also briefly discusses complementary and alternative pharmacotherapies and the use of omega-3 fatty acids. The chapter includes an in-depth review of the clinical use of the previously listed medications for bipolar depression, mania, mixed episodes, and bipolar maintenance. It also reviews the risks of using antidepressants for bipolar depression. It also discusses the use of mood stabilizers in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of mood stabilizers that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings and Food and Drug Administration indications.

Antidepressants

Psychopharmacology ◽

10.1093/med/9780197537046.003.0002 ◽

2020 ◽

pp. 15-84

Author(s):

Arash Ansari ◽

David N. Osser

Keyword(s):

Selective Serotonin Reuptake Inhibitors ◽

Unipolar Depression ◽

Black Box ◽

Brand Names ◽

Clinical Use ◽

Childbearing Age ◽

Medical Disorders ◽

Black Box Warnings ◽

Norepinephrine Reuptake

The chapter on antidepressants discusses and reviews the use of tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors, as well as bupropion, mirtazapine, nefazodone, trazodone, and the newer antidepressants vilazodone and vortioxetine. It reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, adverse effects, and other risks. The chapter also reviews emerging pharmacotherapies such as ketamine, esketamine, and brexanolone. It also briefly discusses complementary and alternative pharmacotherapies. The chapter includes an in-depth discussion of the clinical use of antidepressants for the treatment of unipolar depression and other psychiatric and medical disorders. It also discusses the use of antidepressants in women of childbearing age, notably in regards to pregnancy and breastfeeding considerations. Finally, each chapter includes a table of antidepressants that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and FDA indications.

Anti-Anxiety Medicines and Hypnotics

Psychopharmacology ◽

10.1093/med/9780197537046.003.0003 ◽

2020 ◽

pp. 85-120

Author(s):

Arash Ansari ◽

David N. Osser

Keyword(s):

Adverse Effects ◽

Food And Drug Administration ◽

Mechanisms Of Action ◽

Black Box ◽

Abuse Potential ◽

Brand Names ◽

Clinical Use ◽

Childbearing Age ◽

The chapter on anti-anxiety medicines and hypnotics discusses and reviews the use of benzodiazepines and barbiturates, medicines without abuse potential used for the treatments of anxiety (such as buspirone, propranolol, clonidine, prazosin, hydroxyzine, pregabalin, gabapentin, and quetiapine), as well as newer hypnotics including “z-drugs” considered for insomnia and sleep. It reviews their mechanisms of action, clinical characteristics, potential medication interactions, adverse effects, as well as their risks of dependence and misuse. It also briefly discusses complementary and alternative pharmacotherapies such as melatonin and cannabidiol. The chapter includes an in-depth discussion of the clinical use of these medications for anxiety and insomnia. It also discusses the use of anxiolytics in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of commonly used anti-anxiety medicines and hypnotics that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings and Food and Drug Administration indications.

Treatments for Substance Use Disorders

Psychopharmacology ◽

10.1093/med/9780197537046.003.0007 ◽

2020 ◽

pp. 267-324

Author(s):

Arash Ansari ◽

David N. Osser

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Black Box ◽

Brand Names ◽

Opioid Use ◽

Childbearing Age ◽

Black Box Warnings ◽

Amphetamine Use ◽

Opioid Use Disorders

The chapter on treatments for substance use disorders discusses and reviews the use of medication-assisted treatments with (a) methadone, buprenorphine/naloxone, and naltrexone for opioid use disorders; (b) disulfiram, acamprosate, naltrexone, and several off-label medications for alcohol use disorders; and (c) nicotine replacement therapies, bupropion, and varenicline for tobacco use disorders. The chapter reviews the mechanisms of action, clinical characteristics, potential medication interactions, and adverse effects of these medications, followed by an in-depth discussion of their clinical use in these disorders. The chapter also briefly reviews several non-Food and Drug Administration (FDA)-approved medicines studied for cocaine, cannabis, and amphetamine use disorders. It also briefly discusses complementary and alternative pharmacotherapies, such as the use of cannabinoids. It also discusses the use of these medicines in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of approved substance use disorder medicines that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and FDA indications.

Are Atypical Antipsychotics the Least Detrimental Alternative?

McMaster University Medical Journal ◽

10.15173/mumj.v16i1.2019 ◽

2019 ◽

Vol 16 (1) ◽

pp. 91-104

Author(s):

Holly Breton

Keyword(s):

Metabolic Syndrome ◽

Side Effect ◽

Atypical Antipsychotics ◽

First Generation ◽

Extrapyramidal Symptoms ◽

Treatment Resistant ◽

Major Depressive ◽

Second Generation Antipsychotics ◽

Potential Risks ◽

Decrease Life Expectancy

Antipsychotics are typically used for the treatment of schizophrenia, bipolar disorder, and recently, treatment resistant major depressive disorder. A significant, and very concerning, side effect present with first generation antipsychotics is extrapyramidal symptoms, which are disorders of movement. With the advent of atypical antipsychotics, also known as second-generation antipsychotics, these symptoms are purported to be much less frequent and pronounced than they were with the first generation medications. Numerous hypotheses have been proposed as to why atypical antipsychotics produce fewer extrapyramidal symptoms compared to first generation antipsychotics, which this paper will review. Unfortunately, despite the fact that atypicals have reduced extrapyramidal symptoms in those taking antipsychotics, extrapyramidal symptoms are still an unpleasant and potentially dangerous side effect, which can be difficult to detect, and difficult, or even impossible, to treat. Additionally, atypical antipsychotics result in other potentially very serious side effects, specifically and most commonly, metabolic syndrome, which can decrease life expectancy significantly. However, metabolic syndrome, unlike extrapyramidal symptoms, may be preventable in highly motivated and well-supported patients. Thus, this paper concludes that the benefits of the atypical antipsychotics (reduced extrapyramidal symptoms) outweigh the potential risks for the majority of patients.

Psychopharmacology

10.1093/med/9780197537046.001.0001 ◽

2020 ◽

Author(s):

Arash Ansari ◽

David Osser

Keyword(s):

Primary Care Physicians ◽

Brand Names ◽

Mood Stabilizers ◽

Therapeutic Effects ◽

Childbearing Age ◽

Clinical Nurse Specialists ◽

Therapeutic Uses ◽

Emerging Therapies ◽

Black Box Warnings ◽

Short And Long Term

Psychopharmacology: A Concise Overview, 3rd Edition discusses and reviews currently available psychiatric medications and their evidence-supported use in current clinical practice. It discusses the therapeutic uses of antidepressants, anti-anxiety medications, antipsychotics, mood stabilizers, stimulants, and other medications for attention-deficit/hyperactivity disorder (ADHD), as well as medicines for substance use disorders. It reviews the medications’ mechanisms of action, therapeutic effects, potential drug–drug interactions and short- and long-term adverse effects and risks. It includes sections on complementary and alternative pharmacotherapies as well as on emerging therapies. Every chapter includes an in-depth discussion of the clinical use of the reviewed classes of medications as they are used for the alleviation of their target psychiatric disorders, such as depression, anxiety disorders, schizophrenia, bipolar disorder, ADHD, and opioid, alcohol, and tobacco use disorders. Treatment challenges and controversies are reviewed. In addition, each chapter discusses the use of these medications in other psychiatric and medical conditions as well. Each chapter also discusses the use of these medications in women of childbearing age, especially in light of pregnancy and breastfeeding considerations. Finally, each chapter includes a table that provides each reviewed medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications. This book provides a concise and accessible overview that would be helpful to medical students, psychiatric residents, psychiatrists, primary care physicians, clinical nurse specialists, and nonmedical mental health practitioners.

First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness

PsycEXTRA Dataset ◽

10.1037/e553822013-001 ◽

2012 ◽

Keyword(s):

Comparative Effectiveness ◽

First Generation ◽

Second Generation ◽

Second Generation Antipsychotics

Pharmakotherapie update

Psychotherapie ◽

10.30820/2364-1517-2020-1-23 ◽

2020 ◽

Vol 25 (1) ◽

pp. 23-32

Author(s):

Gerd Laux

Keyword(s):

First Generation ◽

Second Generation ◽

Therapeutische Maßnahmen ◽

Second Generation Antipsychotics

Für die Therapie schizophrener Erkrankungen sind seit fast 60 Jahren Antipsychotika/Neuroleptika aufgrund ihrer antipsychotischen Wirkung von zentraler Bedeutung. Die Einteilung kann unter verschiedenen Gesichtspunkten erfolgen (chemische Struktur, neuroleptische Potenz, Rezeptorprofil), heute werden üblicherweise unterschieden typische (traditionelle, klassische, konventionelle) Antipsychotika der ersten Generation ‒ »First Generation Antipsychotics« (FGA) ‒ und sog. atypische (»neuere«) Neuroleptika bzw. Antipsychotika der zweiten Generation ‒»Second Generation Antipsychotics« (SGA). Hierzu zählen Aripiprazol, Asenapin, Cariprazin, Clozapin, Olanzapin, Quetiapin, Risperidon, Sertindol und Ziprasidon. Hierbei handelt es sich um keine homogene Gruppe – sowohl neuropharmakologisch (Wirkmechanismus), als auch hinsichtlich klinischem Wirkprofil und dem Nebenwirkungsspektrum bestehen z. T. erhebliche Unterschiede. Neben der Akut-Medikation ist eine Langzeitmedikation bzw. Rezidivprophylaxe mit Antipsychotika für die Rehabilitation vieler schizophrener Patienten im Sinne eines »Stresspuffers« von grundlegender Bedeutung. In Placebo-kontrollierten Studien trat bei Patienten, die über ein Jahr behandelt wurden, bei etwa 30% unter Neuroleptika ein Rezidiv auf, unter Placebo bei mehr als 70%. Für die Langzeitbehandlung bietet sich der Einsatz von Depot-Neuroleptika an, neu entwickelt wurden Langzeit-Depot-Injektionen mit Intervallen von bis zu 3 Monaten. Grundsätzlich ist die niedrigstmögliche (wirksame) Dosis zu verwenden. Im Zentrum der Nebenwirkungen (UAW) standen lange Zeit extrapyramidal-motorische Bewegungsstörungen (EPMS), mit der Einführung von Clozapin und anderen atypischen Antipsychotika der zweiten Generation gewannen andere Nebenwirkungen an Bedeutung. Hierzu zählen Gewichtszunahme, Störungen metabolischer Parameter und ein erhöhtes Risiko für Mortalität und zerebrovaskuläre Ereignisse bei älteren Patienten mit Demenz. Entsprechende Kontrolluntersuchungen sind erforderlich, für Clozapin gibt es aufgrund seines Agranulozytose-Risikos Sonderbestimmungen. Immer sollte ein Gesamtbehandlungsplan orientiert an der neuen S3-Praxisleitlinie Schizophrenie der DGPPN aufgestellt werden, der psychologische und milieu-/sozial-therapeutische Maßnahmen einschließt. Standard ist heute auch eine sog. Psychoedukation, für Psychopharmaka liegen bewährte Patienten-Ratgeber vor.

The Influence of FDA Advisory Information and Black Box Warnings on Consumer Use of Prescription Antidepressants

SSRN Electronic Journal ◽

10.2139/ssrn.1292082 ◽

2008 ◽

Cited By ~ 3

Author(s):

Kristy Parkinson ◽

Joseph Price ◽

Kosali Ilayperuma Simon ◽

Sharon L. Tennyson

Keyword(s):

Black Box ◽