Атипичность атипичных антипсихотиков

The main reason for the development of atypical antipsychotics was to provide an antipsychotic treatment option that was free of EPS and, further, to reduce the risk of tardive dyskinesia. Although many agents now claim to be atypical, the data presented suggest that only clozapine and quetiapine are true atypical antipsychotics. Of the available agents, clozapine and quetiapine show the lowest affinity for and the most rapid release from D2 receptors.3 As a result, clozapine and quetiapine have been shown to have an incidence of EPS that was no different from placebo across the full dosage range.4
Promotion of risperidone, olanzapine, ziprasidone, and possibly aripiprazole has emphasized the atypicality of these agents; however, based on the data presented here, one should question whether these agents are truly atypical antipsychotics. Both risperidone and olanzapine have demonstrated EPS levels similar to placebo at low doses; at higher doses, however, EPS incidence for both agents becomes greater than with placebo.4 Data for ziprasidone are limited; however, ziprasidone appears to have an EPS risk similar to that of risperidone and olanzapine.56,57 Ari-piprazole has been associated with akathisia; however, further study and experience with this drug are needed before definitive conclusions can be drawn.

Atypicality of Atypical Antipsychotics