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It is most often caused by high-potency typical antipsychotics, but can also be caused by high doses of many atypicals, especially those closer in profile to typical ones (that have higher D 2 dopamine receptor affinity and relatively low 5-HT 2 serotonin receptor binding affinity), like paliperidone and amisulpride.
Aribit (Aripiprazole) tablets. Aripiprazole, sold under the brand name Abilify, among others, is an atypical antipsychotic [14] primarily used in the treatment of schizophrenia, bipolar disorder, and irritability associated with autism spectrum disorder; [14] other uses include as an add-on treatment for major depressive disorder and tic disorders. [14]
Typical antipsychotics block the dopamine 2 receptor (D2) receptor, causing a tranquilizing effect. [5] It is thought that 60–80% of D2 receptors need to be occupied for antipsychotic effect. [5] For reference, the typical antipsychotic haloperidol tends to block about 80% of D2 receptors at doses ranging from 2 to 5 mg per day. [5]
Low dose antipsychotics may also be used in treatment of impulse-behavioural and cognitive-perceptual symptoms of borderline personality disorder. [77] Despite the lack of evidence supporting the benefit of antipsychotics in people with personality disorders, 1 in 4 who do not have a serious mental illness are prescribed them in UK primary care.
Many patients will not develop these side effects, although there is still a significant possibility of risks associated with Antipsychotic usage. The percentage of patients affected by side effects like Tardive dyskinesia is significantly high and estimated to be a 20-50% prevalence. [1] [2]
Therapeutic drug monitoring (TDM) is a branch of clinical chemistry and clinical pharmacology that specializes in the measurement of medication levels in blood. Its main focus is on drugs with a narrow therapeutic range , i.e. drugs that can easily be under- or overdosed. [ 1 ]
Rapid diagnosis and treatment is required to improve outcomes. [1] Many people can eventually be restarted on a lower dose of antipsychotic. [2] [3] As of 2011, among those in psychiatric hospitals on antipsychotics about 15 per 100,000 are affected per year (0.015%). [1]
Iloperidone is indicated for the treatment of schizophrenia and mania or mixed episodes in bipolar I disorder. [2] [3] In a 2013 study in a comparison of 15 antipsychotic drugs in effectivity in treating schizophrenic symptoms, iloperidone demonstrated mild effectiveness — as effective as lurasidone, and 13 to 15% less effective than ziprasidone, chlorpromazine, and asenapine. [4]