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Selection of Antipsychotics for the Treatment of Schizophrenia

Wen-Ho Chang

This article reviews guidelines for the selection of antipsychotics in the treatment of schizophrenia. At least five major areas of consideration are essential for the selection of antipsychotics in clinical practice. These include efficacy, side effects, cost, convenience of use and the relative position of an agent in the sequence from pure dopamine receptor targeted (so-called “clean” drug) to multiple receptor targeting (“dirty” drug). The side-effect profile plays the most important role in the determination of drug choice. Among side effects, differential weight gain associated with the use of various antipsychotics has become an incre
asingly important factor in the selection of a firstline medication. Other adverse events such as dose-dependent extrapyramidal symptoms, hyperprolactinem ia-sexual dysfunction, and cardiac conduction effects should also be taken into consideration. Five important safety considerations which should be emphasized in the selection and use of first-line atypical antipsychotics are as follows: (1) to avoid extrapyramidal symptoms; (2) to avoid hyperprolactinemia; (3) to avoid antipsychotic polypharmacy; (4) to avoid antichol inergic medication; and (5) to avoid weight gain.
(Full text in Chinese)
Key Word schizophrenia, antipsychotics, side effects, metabolic disease
Editorial Committe, Taiwanese Journal of Psychiatry
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