Fast Five Quiz: Schizophrenia Management in Adults

Stephen Soreff, MD


August 11, 2020

First-generation antipsychotic drugs tend to cause extrapyramidal adverse effects and elevated prolactin levels, whereas second second-generation drugs are more likely to cause weight gain and abnormalities in glucose and lipid control.

Second-generation drugs are often more expensive than first-generation drugs.

For some years, it was believed that the newer antipsychotic drugs were more effective, but there is now some uncertainty about that. An exception is clozapine, which consistently outperforms the other antipsychotic drugs. Side effects of second-generation drugs (such as atypical antipsychotics) include difficulty concentrating or speaking, changes in blood pressure, constipation, and difficulty sleeping.

First-generation antipsychotic agents are available in generic forms and are less expensive than the newer agents. They are available in a variety of vehicles, including liquid, intramuscular, and transdermal preparations. Some of these agents (haloperidol and fluphenazine) are also available as depot preparations, meaning that a person can be given an injection of a medication every 2-4 weeks. Side effects of first-generation drugs include:

  • Feeling of restlessness, with inability to sit still

  • Blurred vision

  • Extrapyramidal disease (a type of movement disorder)

  • Fainting

  • Low blood pressure

  • Pigmentary retinopathy

  • Tardive dyskinesia (a disorder characterized by involuntary movements of the face, mouth, and tongue)

Learn more about schizophrenia treatment and management.


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