Conventional neuroleptics have been the mainstay of treatment for patients with schizo phrenia for many years. The mechanism of action of these drugs has long been accept ed and their side effects well documented. With the recent introduction of newer antipsy chotics such as clozapine, risperidone, and olanzapine, a new generation of medications has become available whose pharmacologic properties are just beginning to be realized. These newer antipsychotics appear to be superior to conventional neuroleptics in treat ing patients with schizophrenia. Because of their reduced neurotoxicity, the newer antipsychotics may be particularly beneficial in treating psychosis in specific putient populations. This review presents preliminary findings on the use of the newer antipsy chotics for treating psychosis in five patient populations: children and adolescents with schizophrenia and other psychotic disorders; first-episode schizophrenia; dual diagno sis ; bipolar disorder; and elderly patients. Because of the expanded utilities of the newer antipsychotics, psychiatric nurses should be familiar with all available treatment options. (J Am Psychiatr Nurses Assoc [1998]. 4, S42-S52.)
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References
1.
Aguilar, E.J., Keshavan, M.S., Martinez-Quiles, M.D., Hernandez, J., Gomez-Beneyto, M., & Schooler, N.R. (1994). Predictors of acute dystonia in first-episode psychotic patients. American Journal of Psychiatry,151, 1819-1821.
2.
Akiksal, H.S. (1996). The prevalent clinical spectrum of bipolar disorders: Beyond DSM-IV. journal of Clinical Psychopharmacology, 16(Suppl. 1), 4S-14S.
3.
Armenteros, J.L., Whitaker, A.H., & Gorman, J.M. (1995). An open trial of risperidone in adolescents with schizophrenia. Paper presented at the meeting "Campaign on Schizophrenia 1995," Florence, Italy.
4.
Beiser, M., Bean, G., Erickson, D., Zhang, J., Iacono, W.G., & Rector, N.A. (1994). Biological and psychosocial predictors of job performance following a first episode of psychosis. American Journal of Psychiatry,151, 857-863.
5.
Bennet, J.A., Stanton, S.P., Wilson, D.R., Keck, P.E., McElroy, S.L., Balestreri, T., & Kizer, D. (1993, May). Clinical predictors of acute risperidone in elderly patients with schizophrenia and schizoaffective illness. Poster presented at the annual meeting of the New Clinical Drug Evaluation Unit, Boca Raton, FL.
6.
Birchwood, M., & Macmillan, F. (1993). Early intervention in schizophrenia. Australian andNew Zealand Journal of Psychiatry, 27, 374-378.
7.
Birmaher, B., Baker, R., Kapur, S., Quintana, H., & Ganguli R. (1992). Clozapine for the treatment of adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 160-164.
8.
Blanz, B., & Schmidt, M.H. (1993). Clozapine for schizophrenia [Letter]. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 223-224.
9.
Borison, R.L., Davidson, M., & Berman, I. (1995, October). Risperidone treatment in elderly patients with schizophrenia or dementia. Poster presented at the annual meeting ofHospital and Community Psychiatry, San Diego, CA.
10.
Bowden, C.L. (1996). Role of newer medications for bipolar disorder . Journal of Clinical Psychopharmacology, 16(Suppl. 1), 48S-55S.
Buckley, P., Thompson, P., Way, L., & Meltzer, H.Y. (1994). Substance abuse among patients with treatment-resistant schizophrenia: Characteristics and implications for clozapine therapy. American Journal of Psychiatry, 151, 385-389.
13.
CGI Clinical Global Impressions: ECDEU Assessment Manual for Psychopharmacology (Revised Edition). (1976). Rockville, MD: US Department of Health, Education, and Welfare; 218-222.
14.
Chakos, M.H., Lieberman, J.A., Bilder, R.M., Borenstein, M., Lerner, G., Bogerts, B., Wu, H., Kinon, B., & Ashtari, M. (1994). Increase in caudate nuclei volumes of first-episode schizophrenic patients taking antipsychotic drugs. American Journal of Psychiatry, 151, 1430-1436.
15.
Chengappa, K.N.R., Baker, R.W., Kreinbrook, S.B., & Adair, D. (1995). Clozapine in female geriatric patients with psychoses . Journal of Geriatric Psychiatry and Neurology, 8, 12-15.
16.
Cosgrove, F. (1994). Recent advances in paediatric psychopharmacology: A brief overview. Human Psychopharmacology Clinical Experimental , 9, 381-382.
17.
Cozza, S.J., & Edison, D.L. (1994). Risperidone in adolescents [Letter]. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 1211.
18.
DasGupta, K., & Young, A. (1991). Clozapine-induced neuroleptic malignant syndrome . Journal of Clinical Psychiatry, 52, 105-107.
19.
Dicker, R., & Solis, S. (1996). Risperidone treatment of a psychotic adolescent. Letter. American Journal of Psychiatry,153, 441-442.
20.
Dwight, M.M., Keck, Jr., P.E., Stanton, S.P., Strakowski, S.M., & McElroy , S.L. (1994). Antidepressant activity and mania associated with risperidone treatment of schizoaffective disorder [Letter]. Lancet, 344, 554-555.
21.
Eliopoulos, E. (1997). In Gerontological Nursing (4th ed.). Philadelphia, PA: J.B. Lippincott.
22.
Emsley, R.A., & McCreadie, R. (1995, May). Risperidone in the treatment of first episode psychotic patients: A double-blind multicenter comparison with haloperidol . Paper presented at the annual meeting of the American Psychiatric Association, Miami, FL.
23.
Erickson, D.H., Beiser, M., Iacono, W.G., Fleming, J.A., & Lin, T.Y. (1989). The role of social relationships in the course of first-episode schizophrenia and affective psychosis. American Journal of Psychiatry,146, 1456-1461.
24.
Fischer, E.P., Owen, Jr., R.R., & Cuffel, B.J. (1996). Substance abuse, community service use, and symptom severity of urban and rural residents with schizophrenia . Psychiatric Services, 47, 980-984.
Fras, I., & Major, L.F. (1995). Clinical experience with risperidone [Letter] . Journal of the American Academy of Child and Adolescent Psychiatry, 34, 833.
27.
Frazier, J.A., Gordon, C.T., McKenna, K., Lenane, M.C., Jih, D., & Rapoport, J.L. (1994). An open trial of clozapine in 11 adolescents with childhood-onset schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 658-663.
28.
Glazer, W.M., & Ereshefsky, L. (1996). A pharmacoeconomic model of outpatient antipsychotic therapy in "revolving door" schizophrenic patients . Journal of Clinical Psychiatry, 57, 337- 345.
29.
Gonzalez, A., & Michanie, C. (1992). Clozapine for refractory psychosis. [Letter]. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1169-1170.
30.
Gordon, C.T., Frazier, J.A., McKenna, K., Giedd, J., Zametkin, A., Zahn, T., Hammer, D., Hong, W., Kaysen, D., & Albus, K.E. (1994). Childhood-onset schizophrenia: An NIMH study in progress. Schizophrenia Bulletin, 20, 697-712.
31.
Helgason, L. (1990). Twenty years' follow-up of first psychiatric presentation for schizophrenia: What could have been prevented?Acta Psychiatrica Scandinavica, 81, 231-235.
32.
Hendren, R.L. (1996). Management of psychosis in adolescents suffering from schizophrenia and bipolar disorder. EssentialPsychopharmacology , 1, 38-53.
33.
Hoff, A.L., Harris, D., Faustman, W.O., Beal, M., DeVilliers, D., Mone, R.D., Moses, J.A., & Csemansky, J.G. (1996). A neuropsychological study of early onset schizophrenia. Schizophrenia Research, 20, 21-28.
34.
Jacobsen, F.M. (1995). Risperidone in the treatment of affective illness and obsessive-compulsive disorder. Journal of Clinical Psychiatry , 56, 423-429.
35.
Jeanblanc, W., & Davis, Y.B. (1995). Risperidone for treating dementia-associated aggression [Letter]. American Journal of Psychiatry,152, 1239.
Jeste, D.V., Lacro, J.P., Gilbert, P.L., Kline, J., & Kline, N. (1993). Treatment of late-life schizophrenia with neuroleptics . Schizophrenia Bulletin, 19, 817-830.
38.
Jibson, M.D., & Tandon, R. (1995). The negative symptoms of schizophrenia. Directions in Psychiatry, 15, 1-8.
39.
Kane, J., Honigfeld, G., Singer, J., Meltzer, H., and the Clozaril Collaborative Study Group. (1988). Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789-796.
40.
Katz, I., Brecher, M. & Clyde, C. (1997). Risperidone in the treatment of psychosis and aggressive behavior in patients with dementia. American College of Neuropsychopharmacology, 36th Annual Meeting, Hawaii, December 8-12, 1997. Scientific Abstracts: 292.
41.
Keck, Jr., P.E., & McElroy, S.L. (1996). Outcome in the pharmacologic treatment of bipolar disorder. Journal of Clinical Psychopharmacology, 16(Suppl. 1), 15S-23S.
42.
Keck, Jr.,P.E., McElroy, S.L., & Nemeroff, C.B. (1992). Anticonvulsants in the treatment of bipolar disorder. Journal of Neuropsychiatry and Clinical Neurosciences, 4, 395-405.
43.
Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.U., & Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry,51, 8-19.
44.
Kopala, L.C., Fredrikson, D., Good, K.P., & Honer, W.G. (1996). Symptoms in neuroleptic-naïve, first episode schizophrenia: Response to risperidone. BiologicalPsychiatry, 39, 296-298.
45.
Koreen, A.R., Siris, S.G., Chakos, M., Alvir, J., Mayerhoff, D., & Lieberman, J.A. (1993). Depression in first-episode schizophrenia. American Journal of Psychiatry,150, 1643-1648.
46.
Kumra, S., Jacobsen, L., Frazier, J., & Rapoport, J.L. (1996, May). Clozapine for treatment resistant childhood-onset schizophrenia: A double-blind comparison with haloperidol . Poster presented at the annual meeting of the New Clinical Drug Evaluation Unit, Boca Raton, FL.
47.
Lacro, J.P., Eastham, J.H., Gilbert, P., Gierz, M., Aravagiri, M., & Jeste, D.V. (1996, May). Risperidone treatment in older patients with psychosis. Poster presented at the annual meeting of the New Clinical Drug Evaluation Unit, Boca Raton, FL .
48.
Levkovitch, Y., Kaysar, N., Kronnenberg, Y., Hahgai, H., & Gaoni, B. (1994). Clozapine for schizophrenia [Letter]. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 431.
49.
Lieberman, J., Jody, D., Geisler, S., Alvir, J., Loebel, A., Szymanski, S., Woemer, M., & Borenstein, M. (1993). Time course and biologic correlates of treatment response in first-episode schizophrenia. Archives of General Psychiatry,50, 369-376.
50.
Loebel, A.D., Lieberman, J.A., Alvir, J.M.J., Mayerhoff, D.I., Geisler, S.H., & Szymanski, S.R. (1992). Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry,149, 1183-1188.
51.
Lykes, W.C., & Cueva, J.E. (1996). Risperidone in children with schizophrenia. [Letter] . Journal of the American Academy of Child and Adolescent Psychiatry, 35, 405-406.
52.
Madhusoodanan, S., Brenner, R., Araujo, L., & Abaza, A. (1995). Efficacy of risperidone treatment for psychoses associated with schizophrenia, schizoaffective disorder, bipolar disorder, or senile dementia in 11 geriatric patients: A case series. Journal of Clinical Psychiatry, 56, 514-518.
53.
McElroy, S.L., Dessain, E.C., Pope, Jr., H.G., Cole, J.O., Keck, Jr., P.E., Frankenberg, FR, Aizley, H.G., & O'Brien, S. (1991). Clozapine in the treatment of psychotic mood disorders, schizoaffective disorder, and schizophrenia. Journal of Clinical Psychiatry, 52, 411-414.
54.
McGlashan, T.H., & Carpenter,Jr., W.T. (1976). Postpsychotic depression in schizophrenia. Archives of General Psychiatry, 33, 231-239.
55.
Mirin, S.M., & Weiss, R.D. (1993). Substance abuse and mental illness. In: R.J. Frances (Ed.), Clinical textbook of addictive disorders (pp. 271-298). New York: Guilford Press.
56.
Mozes, T., Toren, P., Chernauzan, N., Mester, R., Yoran-Hegesh, R., Blumensohn, R., & Weizman, A. (1994). Clozapine treatment in very early onset schizophrenia . Journal of the American Academy of Child and Adolescent Psychiatry, 33, 65-70.
57.
Mueser, K.T., Yarnold, P.R., Levinson, D.F., Singh, H., Bellack, A.S., Kee, K., Morrison, R.L., & Yadalam, K.G. (1990). Prevalence of substance abuse in schizophrenia: Demographic and clinical correlates. Schizophrenia Bulletin , 16, 31-56.
58.
Munk-Jorgensen, P., & Mortensen, P.B. (1989). Schizophrenia: A 13-year follow-up. Diagnostic and psychopathological aspects. Acta Psychiatrica Scandinavica, 79, 391-399.
59.
Osman, O.T. (1995, March). Crisis stabilization of the dually diagnosed . Paper presented at the Cherry Blossom Festival Psychiatric Symposium, Macon, GA.
Patel, J.K., Green, A.I., Banov, M.D., Tohen, M., Schatzberg, A.F., & Cole, J.O. (1995, May). Clozapine in treatment refractory mania and psycbosis. Paper presented at the annual meeting of the American Psychiatric Association, Miami, FL.
62.
Pickar, D. (1995, May). Towards a new generation of antipsychotic drugs. In Progress in psychoses. Symposium conducted at the 148th Annual Meeting of the American Psychiatric Association, Miami, FL.
63.
Pitner, J.K., Mintzer, J.E., Pennypacker, L.C., & Jackson, C.W. (1995). Efficacy and adverse effects of clozapine in four elderly psychotic patients. Journal of Clinical Psychiatry , 56, 180-185.
64.
Prudo, R., & Munroe-Blum, H. (1987). Five-year outcome and prognosis in schizophrenia: A report from the London Field Research Center of the International Pilot Study of Schizophrenia. American Journal of Psychiatry , 150, 345-354.
65.
Remschmidt, H.E., Schulz, E., Martin, M., Warnke, A., & Trott, G.E. (1994). Childhood-onset schizophrenia: History of the concept and recent studies. Schizophrenia Bulletin, 20, 727-745.
66.
Russell, A.T., Bott, L., & Sammons C. (1989). The phenomenology of schizophrenia occurring in childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 3, 399-407.
67.
Scahill, L., Chappell, P.B., King, R.A., Leckman, J.F., & Lombroso, P.J. (1995, May). Risperidone treatment of children and adolescents with Tourette's syndrome and chronic tic disorder: A preliminary report. Poster presented at the annual meeting of the New Clinical Drug Evaluation Unit, Marco Island, FL.
68.
Schwartz, S.R., & Goldfinger, S.M. (1981). The new chronic patient: Clinical characteristics of an emerging subgroup. Hospital and Community Psychiatry, 32, 470-474.
69.
Spencer, E.K., Kafantaris, V., Padron-Gayol, M.V., Rosenberg, C.R., & Campbell, M. (1992). Haloperidol in schizophrenic children: Early findings from a study in progress. Psychopharmacology Bulletin, 28, 183-186.
70.
Steinberg, J.R. (1994). Substance abuse and psychosis. In: R.J. Ancill, S. Holliday , & J. Higenbottam (Eds.), Schizophrenia: Exploring the spectrum of psychosis. (pp. 259-289). New York: Wiley.
71.
Sternlicht, H.C., & Wells, S.R. (1995). Risperidone in childhood schizophrenia [Letter] . Journal of the American Academy of Child and Adolescent Psychiatry, 34, 540.
72.
Swanson, Jr., C.L., Price, W.A., & McEvoy, J.P. (1995). Effects of concomitant risperidone and lithium treatment. [Letter]. American Journal of Psychiatry, 152, 1096.
73.
Tariot, P.H., Podgorski, C.A., Blazina, L., & Leibovici, A. (1993). Mental disorders in the nursing home: Another perspective. American journal ofPsychiatry, 150, 1063-1069.
74.
Tarsy D. (1996). Risperidone and neuroleptic malignant syndrome [Letter]. Journal of the American Medical Association, 275, 446.
75.
Thara, R., & Eaton, W.W. (1996). Outcome of schizophrenia: The Madras longitudinal study. Australian andNew Zealand Journal of Psychiatry, 30, 516-522.
76.
The Scottish Schizophrenia Research Group. ( 1992). The Scottish first episode schizophrenia study. VIII. Five-year follow-up: Clinical and psychosocial findings. British Journal of Psychiatry, 161, 496-500.
77.
Tohen, M., Zarate, Jr., C.A., Centorrino, F., Hegarty, J.I., Froeschl, M., & Zarate, S.B. (1996). Risperidone in the treatment of mania. Journal of Clinical Psychiatry, 57, 249-253.
78.
Umbricht, D., & Kane, J.M. (1996). Medical complications of new antipsychotic drugs . Schizophrenia Bulletin, 22, 475-483.
79.
Umbricht, D., & Kane, J.M. (1995). Risperidone: Efficacy and safety. Schizophrenia Bulletin, 21, 593-606.
80.
Werry, J.S., McClellan, J.M., & Chard, L. (1991). Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: A clinical and outcome study. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 457-465.
81.
Wirsching, W.C. (1996, March). Special populations with psychosis: First break patients, adolescents and geriatric patients and serotonin-dopamine antagonists. Progress in Psychoses. Symposium sponsored by Janssen Pharmaceutica. Los Angeles, CA.
82.
Young, RC, Biggs, JT, Zeigler, VE, & Meyer DA (1978). A rating scale for mania: Reliability, validity, and sensitivity. British Journal of Psychiatry, 133, 429-435.
83.
Zarate, Jr., C.A., Tohen, M., & Baldessarini, R.J. (1995). Clozapine in severe mood disorders. Journal of Clinical Psychiatry, 56, 411-417.
84.
Zarate, Jr., C.A., Tohen, M., Banov, M.D., Weiss, M.K., & Cole, J.O. (1995). Is clozapine a mood stabilizer? Journal of Clinical Psychiatry, 56, 108-112.
