Non sedating antipsychotic medicatoin
5-Hydroxytryptamine-2 antagonist increases human slow wave sleep. When treating agitated patients, many clinicians consider calming effects and true antipsychotic effects to be one in the same, which is not correct. Expert Consensus Guideline Series Treatment of schizophrenia. Aripiprazole is a dopamine D2 partial agonist, serotonin 5HT1A partial agonist, and serotonin 5HT2A antagonist. Patients with acute exacerbation of psychosis often have insomnia and frequently report paranoia that “something” will happen to them while they sleep. Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: a double-blind, placebo-controlled comparison with intramuscular haloperidol.
Treatment of special populations with the atypical antipsychotics.
Four SGAs—risperidone, olanzapine, quetiapine, and ziprasidone—act as dopamine D2 and 5HT2A antagonists.
Hypothalamic arousal regions are activated during modafinil-induced wakefulness. Ask patients if they nap during the day or just lie around, and if they want to do things but can’t: Antipsychotics are thought to exert their effect by antagonism of postsynaptic dopamine D2 and serotonin 5HT2A receptors and possibly other receptors in the brain. Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis.
The authors suggested that cost appears to becoming a less issue, although atypical anti-psychotics are more expensive especially when new to the market. There were some limitations with the review some drugs are not currently used in the UK, others have a good evidence base underpinning them but not included in the analysis, for example, sulpiride and perphenazine.
Dosing still appears key, although this is not really clear from this review, often trials which compare atypicals with typical anti-psychotics use typical doses above the 7.5 mg Haloperidol or less recommended for treatment of acute psychosis (see here). There were some potential problems with the analysis, for example, the use of all cause discontinuation as a proxy measure of acceptability.