Talk:Atypical antipsychotic/Archive 1

Melperone is an atypical antipsychotic?

Melperone (Buronil, Eunerpan, Harmosin, Melneurin and other generic/trade names) is a typical sedative neuroleptic/antipsychotic, used for over 30 years in Europe now. Its only atypical propriety is, that it (and pipamperone/floropipamide, Dipiperon) is a butyrophenone derivative and is not a highly potent neuroleptic, such as other butyrophenone derivatives (haloperidol, benperidol, spiroperidol, trifluperidol, bromperidol or moperone). It causes quite little EPMS, but so does e.g. thioridazine and is not classified an atypical antipsychotic. Melperone is low-potency, sedative, 1st generation butyrophenone antipsychotic.--Spiperon 21:47, 3 May 2007 (UTC)

I slightly hope nobody will want this back.

"More recent research is questioning the notion that second generation anti-psychotics are superior to first generation typical anti-psychotics. Using a number of parameters to assess quality of life University of Manchester researchers found that typical anti-psychotics were no worse than atypical anti-psychotics. The research was funded by the National Health Scheme of the UK.[1]"

Everything under, including risperidone had given me pains impossible to explain. It equates to continuous physical torture. Well I'm intelligent and particularly sensitive in nervous reaction, but the damage was equal to that of the mountain shepherd boy, with the difference that he was too stall to tell. He does not need the psychological functions that are disabled by the old medication and he has a higher thresh hold of pain, so he seems OK. Normal people feel just dizzy, they do not now the length at which their superior processes are disturbed by the old medication. In general there can be no intellectual recovery by using the old medication. Proper social involvement does require the processes that are disabled by them. Quality of life can not be measured good enough by people who measure contentedness with non-activity. The damage is taken. The parameters are subjective. My incapacity was totally there, a billion crisp shades of unknown pain and disabilities, including the one to convince the doctor the faint complain for the pain is your last and maximum strength, not a usual psycho-paranoid complaint against medicine and signature on documents. GOD I hate them, theory and lab doctors. Rats. Whores. Demented messengers of authority and current overwhelming empirical evidence.

So I just hope... . Watiki 15:58, 4 September 2007 (UTC)

Inclusion of critical viewpoints

There seems to be very little inclusion of critical viewpoints on this page. I'm referring to the studies which indicate the inefficiency of antipsychotics, and potential for harm to the brain (beyond Tardive Dyskinesia). Ninmat (talk) 01:58, 1 September 2008 (UTC)

Pediatric indications

"None of the atypicals (Clozaril, Risperdal, Zyprexa, Seroquel, Abilify and Geodon) have been approved for children, and there is little research on their effects on children. "

I believe this statement is outdated, considering: Abilify is approved for schizophrenia in children aged 13-17; manic or mixed episodes of bipolar I disorder in children aged 10-17. Risperdal is approved for the same two indications, as well as irritability associated with autistic disorder in children aged 5-16. (Source: Abilify and Risperdal prescribing information). Hojoseph99 (talk) 22:01, 20 August 2009 (UTC)

Cut the technobabble, please

Intro:

During the course of treatment atypical antipsychotics are associated with the following benefits higher rate of responders, efficiency in patients with refractory disease, ...

What the heck is this supposed to mean, to someone not schooled in the ways of medical technobabble? Wikipedia has a wide audience including high school students, so articles should be written using common terminology most people would understand. These two benefits use nearly impenetrable language, though that may be the intention, so normal people don't really know what is being described.

higher rate of responders -- probably more patients are likely to keep taking it, rather than stop taking it due to the motor control and other serious side effects that can manifest with the 1st-gen typicals

efficiency in patients with refractory disease -- refractory disease redirects to disease, which says nothing of refractories. This appears to mean "resistance to treatment", though it's unclear if this means the patient's body is resisting treatment, or if the patient themselves is resisting treatment due to not taking (or not wanting to take) the drug, for whatever reason, though probably again due to unpleasant 1st-gen side effects.

DMahalko (talk) 05:35, 1 July 2010 (UTC)

Summary could be improved.

After reading the introduction, my grasp on the differences between typical anti-psychotic drugs and atypical ones is tenuous at best. What makes this family of anti-psycohtic drugs unique or different from other types or groups? This question seems to be unanswered. Furthermore, medical vocabulary such as the word, "generations" to describe different types of drugs further obscures meaning, by the fact that it is introduced without specific reference to what the word refers. Upon further reading of the article however, it can be ascertained that these drugs are also referred to as Second Generation Antipsychotics, and that there is notable controversy over the differences in the effectiveness and mechanisms of these drugs versus First Generation drugs, if any. The presence of debate over this issue ought to be introduced and characterized in the first paragraph in order to better establish the differences or similarities between this class of drug and First Generation drugs, and perhaps some background information would further clarify which aspects of the drugs are controversial. — Preceding unsigned comment added by Kaimakides (talk • contribs) 15:08, 20 January 2012 (UTC)

Hi, thats because there is no difference, both drug types will kill you. pharmaceutical companies call them different names because of patent issues (they get exclusive rights to sell them get it?). some people say new ones are much worse. It's just poison! — Preceding unsigned comment added by 188.76.188.159 (talk) 18:43, 13 July 2013 (UTC)

Fake articles by "Dirk Ziskoven" ?

The article cited two articles by "Dirk Ziskoven" or "Ziskoven Dirk" but Google and Google Scholar can't find them and the PUBMED IDs link to completely different articles. I've deleted the citations and replaced with "citation needed" tags, but maybe the associated text should go as well? (In particular, one citation supports switching to another SGA instead of older antipsychotics when discontinuing clozapine/olanzapine due to those two drugs' metabolic side effects.) — Preceding unsigned comment added by Gerhard gentzen (talk • contribs) 17:43, 1 August 2013 (UTC)

Should we rename the article Second-Generation Antipsychotic?

Nowadays the term atypical antipsychotic is being challenged due to the fact that it tends to imply some special properties these medications have over the typical antipsychotic and since these special properties have not been entirely agreed upon it may be more accurate to refer to these agents as second-generation antipsychotics. Fuse809 (talk) 01:25, 10 October 2013 (UTC)

== Does anybody find this article to have a very biased, negative point of view?

I am having trouble gleaning meaning from this article, as it comes across as a nonobjective slam piece. I expected to find a discussion of the article's point of view on this edit page, but it looks like nobody else here is seeing this slant. I am no expert on antipsychotics, and have no particular point of view on the subject. Does anyone else find this article to be polemical, and therefore not terribly informative? — Preceding unsigned comment added by 71.20.8.226 (talk) 01:54, 6 April 2015 (UTC)

===There are some problems with the article, but the overall conclusion that second generation antipsychotics offer minimal or no advantage over first generation antipsychotics is now well-entrenched in treatment guidelines from major psychiatric groups. Our articles are intended to reflect the positions of these expert authorities. Formerly 98 ^{talk|contribs|COI statement} 16:27, 6 April 2015 (UTC)

No data

The following entries in the adverse effects table did not contain any useful information, just quotation marks, and should contain some data before reinsertion:

Comparison of side effects for atypical antipsychotics
Generic Name	Weight gain	Metabolic Effects	EPS	Prolactin	Sedation	Hypotension / Orthostasis	QTc prolongation	Anti-ACheffects	Other Adverse Effects* & Notes
Carpipramine	?	?	?	?	?	?	?	?	?
Clocapramine	?	?	?	?	?	?	?	?	Often classed with typical antipsychotics.
Mosapramine	?	?	?	?	?	?	?	?	Often classed with the typical antipsychotics.

Mikael Häggström (talk) 16:44, 8 March 2016 (UTC)

Practically unverifiable

The adverse effects comparisons table had 9 references at the top, each possibly related to any of the vast number of boxes in the table. I tried to integrate them where I could, but only managed to connect the one on Perospirone to its table entries. I moved the rest to here, because they need to be integrated to their corresponding boxes:

• Leucht S, Cipriani A, Spineli L; et al. (September 2013). "Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis". Lancet. 382 (9896): 951–62. doi:10.1016/S0140-6736(13)60733-3. PMID 23810019.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Taylor, D; Paton, C; Kapur, S (2012). The Maudsley Prescribing Guidelines (12th ed.). Informa Healthcare. pp. 12–152, 173–196, 222–235.
• Komossa, K; Depping, AM; Gaudchau, A; Kissling, W; Leucht, S (December 2010). "Second-generation antipsychotics for major depressive disorder and dysthymia" (PDF). The Cochrane Database of Systematic Reviews (12): CD008121. doi:10.1002/14651858.CD008121.pub2. PMID 21154393.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Brunton, L; Chabner, B; Knollman, B (2010). Goodman and Gilman's The Pharmacological Basis of Therapeutics (12th ed.). McGraw Hill Professional. pp. 417–455.
• Davis, KL; Charney, D; Coyle, JT; Nemeroff, C (2002). Neuropsychopharmacology—The fifth generation of progress. Philadelphia: Lippincott Williams & Wilkins.
• Komossa, Katja; Rummel-Kluge, Christine; Hunger, Heike; Schmid, Franziska; Schwarz, Sandra; Duggan, Lorna; Kissling, Werner; Leucht, Stefan (2010). Komossa, Katja (ed.). "Olanzapine versus other atypical antipsychotics for schizophrenia". Cochrane Database of Systematic Reviews (3): CD006654. doi:10.1002/14651858.CD006654.pub2. PMID 20238348.
• Leucht, Stefan; Cipriani, Andrea; Spineli, Loukia; Mavridis, Dimitris; Örey, Deniz; Richter, Franziska; Samara, Myrto; Barbui, Corrado; Engel, Rolf R; Geddes, John R; Kissling, Werner; Stapf, Marko Paul; Lässig, Bettina; Salanti, Georgia; Davis, John M (2013). "Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis". The Lancet. 382 (9896): 951–62. doi:10.1016/S0140-6736(13)60733-3. PMID 23810019.
• Kishi, Taro; Matsuda, Yuki; Nakamura, Hiroshi; Iwata, Nakao (2013). "Blonanserin for schizophrenia: Systematic review and meta-analysis of double-blind, randomized, controlled trials". Journal of Psychiatric Research. 47 (2): 149–54. doi:10.1016/j.jpsychires.2012.10.011. PMID 23131856.

Mikael Häggström (talk) 17:03, 8 March 2016 (UTC)

External links modified

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Legend of "Relative efficacy of SGAs"

This table should be about efficacy, but the legend states that the pluses and minuses indicate side effects. It seems to me that the legend is incorrect, and perhaps should be moved to another table. 147.91.1.41 (talk) 08:37, 18 October 2016 (UTC)

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Regulatory status dates

I checked the history to see the sourcing on the regulatory status table. This is the part which lists various drugs versus various government regulating bodies, and says which government permits which drug.

Fuse809 added this information in July-August 2013 in a table which also including some tolerability measurements. That's cool.

In March 2016 Mikael Häggström split this one table into two tables, one for regulation and one for drug tolerability. I also think that is better.

A problem was that Fuse cited about 10 sources, but in citing them, just listed them as general references rather than saying what came from where. I was wondering about when the regulation data was accurate. Since it was added in 2013, I am tagging it "as of 2013". Since the citation is uncertain I am tagging it "citation needed". I like this data being in the article but I do wish all the data in it could be easily verified by a source. That is a bit out of the way for me to research and fix.

Thanks for developing this content. Blue Rasberry (talk) 16:09, 30 June 2017 (UTC)

It would indeed be good to have them referenced, but it's unfortunately not a task I will be able to do. Mikael Häggström (talk) 19:28, 30 June 2017 (UTC)

Superior therapeutic benefit false citation

"The 5-HT2A receptor, however, is also believed to play a crucial role in the therapeutic advantages of atypical antipsychotics over their predecessors, the typical antipsychotics."

There is this statement under metabolism. I am not sure why this is under "metabolism" in the first place but more importantly the citation provided, which is this one: https://www.ncbi.nlm.nih.gov/pubmed/23499243 Atypical antipsychotics and effects of adrenergic and serotonergic receptor binding on insulin secretion in-vivo: an animal model by Guenette MD doesn't say anything about it and as such doesn't in any way support this quite controversial claim. — Preceding unsigned comment added by 93.103.78.229 (talk) 13:50, 10 November 2017 (UTC)

Color contrast in side effects table

The use of text colors is a good idea but needing a better choice of colors for contrast against the grayish background. This is especially true for lime green and orange, which would cause less eyestrain as green and dark golden rod (darkgoldenrod), respectively. Although less of an issue, red might do better as firebrick.

current	proposed
lime green	green
orange	dark golden rod
red	firebrick

Opinions? — βox73 (৳alk) 21:04, 1 February 2018 (UTC) (edit: deleted sienna as alternate replacement for orange. — βox73 (৳alk) 21:21, 1 February 2018 (UTC))

@Box73: Mm, I felt that the limegreen, orange, and red had a better pop to them. They look fresher. No offense, but the proposed colors look like rotten fruit compared to the predecessors. I think that they should be changed back. Reixus (talk) 07:24, 6 February 2018 (UTC)

@Reixus: Thank you. I agree the lime green set was more vibrant (remember Fruit Stripe gum?) but they were also difficult to read. I can't argue with the subjective but what pops for you may practically disappear for those who are colorblind or have poor vision. The light gray background only makes it worse. Do what I did: take a look at WP:COLOR. — βox73 (৳alk) 08:27, 6 February 2018 (UTC)

@Box73: Good point and oh yeah! I loved that gum! Yeah, I don't know much about vision problems, but do you know if people with such problems generally see darker pigments more clearly than brighter ones even against a darker background? For me there's no problem with the contrast but the aim is of course the readability for the general public. Go with what you think is best. Happy sailing :) Reixus (talk) 09:27, 7 February 2018 (UTC)

Claim that atypical antipsychotics have no therapeutic benefit for schizophrenia.

@Alexbrn: Re: This edit. Your input: “Overall there is no good evidence that atypical antipsychotics have any therapeutic benefit for treating schizophrenia.” Do you think that this is just a joke? That is a gross insult to the psychiatric profession and a flagrant act of trolling at its best. Moreover, this is what the study reported. “This meta-analysis was conducted to assess the efficacy of available treatments for negative symptoms in schizophrenia.” “Most treatments reduced negative symptoms at follow-up relative to placebo.” ” Although some statistically significant effects on negative symptoms were evident, none reached the threshold for clinically significant improvement.” The study demonstrated some improvement of negative symptoms. It did not deal with the therapeutic benefit for schizophrenia as a whole. I’m going to spare myself from citing the tens of thousands of studies that invalidate your ridiculous claim. Reixus [Talk] [Contribs] 09:36, 21 March 2018 (UTC)

"none reached the threshold for clinically significant improvement" is the key phrase. Alexbrn (talk) 09:54, 21 March 2018 (UTC)

Nevertheless, it also said they reduced negative symptoms compared to placebo, countering your claim that they have no therapeutic benefit for schizophrenia. Coming back later (1-2 days) to catch up on this. Reixus [Talk] [Contribs] 10:41, 21 March 2018 (UTC)

Yes, statistically speaking. But it didn't reach the threshold for clinically significant improvement and so is not considered therapeutically beneficial. Alexbrn (talk) 10:43, 21 March 2018 (UTC)

Add - Reixus - now you're trying to add[1] a bunch of non-WP:MEDRS sources despite knowing well from the discussions at WT:MED this is not going to fly. What is going on? Alexbrn (talk) 10:52, 21 March 2018 (UTC)

@Alexbrn: Didn't you follow the fact that there are exceptions to when primary sources can be added? The primary sources I added in my latest edit were made in addition to and after a secondary source as helpers to the secondary source. As per WP:MEDRS: "Primary sources may be presented together with secondary sources." I suggest you also establish an understanding of the pharmacodynamics of antipsychotics (scroll down to the pharmacodynamics section on the atypical antipsychotics page), and read through the text of various atypical antipsychotics pages, as their binding affinity profiles and studies measuring their effects point to palatable cognitive and mood improvements, even if current studies (for atypical antipsychotics as a whole) point only to modest improvements in overall negative symptoms. After that, I'd like you to explain your position that " Overall there is no good evidence that atypical antipsychotics have any therapeutic benefit for treating the negative symptoms of schizophrenia." In your latest reversion, you've also removed my very comprehensive secondary source study on the fact that antidepressants combined with certain antipsychotics improve negative symptoms, my explanation of clozapine's well-documented positive and negative symptom improvement, and that my concession that secondary sources for documenting possible negative symptom improvements for more modern atypical antipsychotics have not been well-established, although some studies exist. I would ask you to restore the edit, at least for the first two subjects as they're important, since right now I'm thinking of a request for mediation if you don't want to deal with this more constructively. Reixus [Talk] [Contribs] 12:16, 21 March 2018 (UTC)

First, the new Clozapine review was a useful update; added. Otherwise using old, poor sources like PMID 19851515 backed up with primary sources to undercut a recent review is very bad. Please do not use phrases like "secondary sources" in article text. I have no position on this topic; but we do reflect what decent sources say and if that there's no clinical benefit then we say that. If you want further views I suggest you add to the thread you have already got running at WT:MED. Alexbrn (talk) 12:43, 21 March 2018 (UTC)

Punishment

What about using antipsychotics to punish people? E.g. cataracts, brain damage, forced overdosages like they do in russia.

I have seen the death of 7 patients. They all complaint about bedingen forced to take large amounts E.g. 40 mg olanzapine a day causing vomiting blood.

I Status someone going into death of just 1 mg risperidon. Angiodeem. —Preceding unsigned comment added by 178.231.37.210 (talk) 13:20, 22 September 2010 (UTC)

Hi, that is a very good point, please help us include details of these horrible drugs. They should not be given to animals never mind humans.

While corruption certainly exists, even within the medical community, these claims are anecdotal, and would require a reputable source to verify. Ray.MacNeil (talk) 08:10, 21 November 2018 (UTC)

Update binding profile

According to this table https://psychiatryonline.org/doi/epdf/10.1176/appi.books.9780890424841 made by THE AMERICAN PSYCHIATRIC ASSOCIATION updated in 2021, there is some need to double check the binding profile. Iohhnky2005 (talk) 11:54, 6 October 2022 (UTC)