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The use of antipsychotic medications, both first-generation (typical) and second-generation (atypical), is a cornerstone in the treatment of various psychiatric conditions. However, these medications are not without their potential side effects and considerations. This introduction provides insight into the rationale behind the need for vigilant monitoring when administering antipsychotic drugs.
| Aspect | First-Generation Antipsychotics (FGAs) | Second-Generation Antipsychotics (SGAs) |
|---|---|---|
| Drug Classes | • Dopamine receptor antagonists • Various classes, including phenothiazines, butyrophenones, thioxanthenes, dibenzoxazepines, dihydroindoles, and diphenylbutylpiperidines | • Serotonin-dopamine antagonists • Atypical antipsychotics, including risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone, asenapine, lurasidone, iloperidone, cariprazine, brexpiprazole, and clozapine |
| Extrapyramidal Side Effects | Significant risk of extrapyramidal side effects, including muscle stiffness, tremors, and involuntary movements | Reduced risk of extrapyramidal side effects compared to FGAs |
| Common Anticholinergic Adverse Effects | Dry mouth - Constipation - Urinary retention | Significant weight gain - Potential development of metabolic syndrome |
| Specific Monitoring Parameters | Not specified | • Specific monitoring guidance is available ( NICE guidance quoted below ) • Personal and family history of diabetes mellitus • Dyslipidemia • Weight - Height - Waist circumference • Blood pressure • Fasting plasma glucose • Fasting lipid profile for all patients • Additional considerations for certain SGAs, e.g., risperidone's side effects and paliperidone's temperature... |
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