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Typical antipsychotics sometimes referred to as first-generation antipsychotics, are a class of psychotropic drug used to treat the symptoms ofpsychosis. Psychosis is defined as a behavior in which a person loses touch with reality, often manifesting with hallucinations anddelusions.

Despite the possible side effects, typical antipsychotics still have their place in the first-line treatment of certain mental illnesses as well as in subsequent therapies when other drugs fail.

Conditions Associated With Psychotic Episodes

The physical conditions most commonly associated with psychosis include epilepsy, advanced HIV infection, Parkinson’s disease, stroke, brain tumors, aging-related dementia, and methamphetamine abuse.

Approved Typical Antipsychotics

Typical antipsychotics were first developed in the 1950s to treat psychosis. The usage of the drugs has since been expanded to include acute mania, agitation, and other serious mood disorders.

Depending on your symptoms, the doctor may choose to use a low-potency, medium-potency, or high-potency typical antipsychotic. Generally speaking, the lower potency ones have more intolerable side effects but are slightly less likely to cause movement disorders. This is not always the case, of course, and the choice of drug depends as much on its appropriate use as its potency.

In the end, typical antipsychotics are not one-size-fits-all. As such, treatment should always be individualized, although it may take several attempts before you hit upon the right drug combination.

Low-potencytypical antipsychotics include:

Medium-potencytypical antipsychotics include:

High-potencytypical antipsychotics include:

Side Effects of Antipsychotics

Side effects can vary based on the drug or combinations of drug used. Some of the side effects may be mild and short-lasting; others can compound over time and increase the risk of other undesirable effects.

The biggest concern is the risk ofextrapyramidal side effects (EPS), the tell-tale side effects that affect body movement and speech. In the past, the term “Thorazine shuffle” was coined because of the impact the drug had on movement and muscle control.

The range of EPS can vary and may include:

Other, less debilitating side effects include upset stomach, weight gain, dry mouth, blurry vision, constipation, vomiting, drowsiness, and orthostatic hypotension (low blood pressure when standing up).

In rare cases, a life-threatening drug reaction, known asneuroleptic malignant syndrome, may occur, causing high fever, muscle rigidity, altered mental state, and dysfunction of the autonomic nervous system (which regulates heart rate, breathing rate, body temperature, digestion, and body sensations).

Overall, EPS will affect three in five typical antipsychotic users to some degree. By contrast, atypical antipsychotics will cause EPS in one in four users.

Similarly, high-potency typical antipsychotics are more likely to cause EPS, orthostatic hypotension, and drowsiness than low-potency one. While low-potency typical antipsychotics generally have fewer EPS symptoms, they are more likely to affect the parasympathetic nervous system, causing abnormally slowed heart rate, low blood pressure, blurry vision, dry mouth, and breathing constriction.

In 2005, the U.S. Food and Drug Administration (FDA) issued ablack box warning on all atypical antipsychotic drugsdue to the increased risk of death in older adults with dementia-related psychosis. They extended this warning to typical antipsychotic medications in 2008.

Combination Therapy

When used to treat mental illness, antipsychotics are usually prescribed in combination with other drugs, such as mood stabilizers, antidepressants, and anti-anxiety medications.

1 SourceVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gill SS, Bronskill SE, Normand S-LT, et al.Antipsychotic drug use and mortality in older adults with dementia.Ann Intern Med. 2007;146(11):775-786. doi:10.7326/0003-4819-146-11-200706050-00006Additional ReadingDivac N, Prostran M, Jakovcevski I, Cerovac N.Second-generation antipsychotics and extrapyramidal adverse effects.Biomed Res Int. 2014;2014:656370. doi:10.1155/2014/656370Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU.Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis.Int J Neuropsychopharmacol. 2013;16(6):1205-18. doi:10.1017/S1461145712001277Cunningham Owens, D. (2014)A Guide to the Extrapyramidal Side-Effects of Antipsychotic Drugs(Second Edition). Cambridge (GB): Cambridge University Press. ISBN-10: 110702286X.Kasper, D.; Fauci, A.; Hauser, S. et al. (2011)Harrison’s Principles of Internal Medicine(18th Edition). New York: McGraw Hill Education, 2015. ISBN-10: 007174889X.

1 Source

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gill SS, Bronskill SE, Normand S-LT, et al.Antipsychotic drug use and mortality in older adults with dementia.Ann Intern Med. 2007;146(11):775-786. doi:10.7326/0003-4819-146-11-200706050-00006Additional ReadingDivac N, Prostran M, Jakovcevski I, Cerovac N.Second-generation antipsychotics and extrapyramidal adverse effects.Biomed Res Int. 2014;2014:656370. doi:10.1155/2014/656370Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU.Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis.Int J Neuropsychopharmacol. 2013;16(6):1205-18. doi:10.1017/S1461145712001277Cunningham Owens, D. (2014)A Guide to the Extrapyramidal Side-Effects of Antipsychotic Drugs(Second Edition). Cambridge (GB): Cambridge University Press. ISBN-10: 110702286X.Kasper, D.; Fauci, A.; Hauser, S. et al. (2011)Harrison’s Principles of Internal Medicine(18th Edition). New York: McGraw Hill Education, 2015. ISBN-10: 007174889X.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Gill SS, Bronskill SE, Normand S-LT, et al.Antipsychotic drug use and mortality in older adults with dementia.Ann Intern Med. 2007;146(11):775-786. doi:10.7326/0003-4819-146-11-200706050-00006

Divac N, Prostran M, Jakovcevski I, Cerovac N.Second-generation antipsychotics and extrapyramidal adverse effects.Biomed Res Int. 2014;2014:656370. doi:10.1155/2014/656370Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU.Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis.Int J Neuropsychopharmacol. 2013;16(6):1205-18. doi:10.1017/S1461145712001277Cunningham Owens, D. (2014)A Guide to the Extrapyramidal Side-Effects of Antipsychotic Drugs(Second Edition). Cambridge (GB): Cambridge University Press. ISBN-10: 110702286X.Kasper, D.; Fauci, A.; Hauser, S. et al. (2011)Harrison’s Principles of Internal Medicine(18th Edition). New York: McGraw Hill Education, 2015. ISBN-10: 007174889X.

Divac N, Prostran M, Jakovcevski I, Cerovac N.Second-generation antipsychotics and extrapyramidal adverse effects.Biomed Res Int. 2014;2014:656370. doi:10.1155/2014/656370

Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU.Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis.Int J Neuropsychopharmacol. 2013;16(6):1205-18. doi:10.1017/S1461145712001277

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