The Distinction Between Antipsychotic Drug Classes Becomes More Blurred

In industry-sponsored phase III randomized clinical trials (RCTs), atypical (or second-generation) antipsychotics have consistently been more effective than neuroleptics (or first-generation antipsychotics), especially for negative symptoms. Atypicals have also been better tolerated, less likely to cause extrapyramidal symptoms, and more acceptable to patients. In the British government–sponsored Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1), researchers randomized 227 patients with chronic schizophrenia to receive a neuroleptic or an atypical antipsychotic for 1 year. Patients’ psychiatrists chose medications and doses and, if a switch was necessary, were expected to prescribe a medication from the same …