Similarities and differences among antipsychotics

Most antipsychotic drugs act equivalently and potently on the symptoms of schizophrenia, with clozapine as the notable exception. Negative symptoms and cognitive deficits are strongly associated with poor prognosis; some reports suggest that these symptoms respond better to second than to first-generation antipsychotics. Although second-generation antipsychotics exert their action through a blockade of dopamine and serotonin receptors (and some have a more complex action), each has a different set of pharmacologic characteristics, including side effects. Due to the differences among antipsychotics available today, optimizing treatment for individual patients requires choosing the most appropriate drug and, if necessary, switching to a different drug if the first proves unsatisfactory. The treating physician must carefully match the diverse needs of schizophrenic patients with the varied characteristics of the second-generation antipsychotics.