Second versus second generation

What are second generation antipsychotics?

Second generation ‘atypical’ antipsychotics are a newer class of antipsychotic than first generation ‘atypical’ antipsychotics. Both are effective for the positive symptoms of schizophrenia, including the experiences of perceptual abnormalities (hallucinations) and fixed, false, irrational beliefs (delusions). It is sometimes claimed that they are more effective than first generation antipsychotics in treating the negative symptoms of schizophrenia. Negative symptoms include a lack of ordinary mental activities such as emotional expression, social engagement, thinking and motivation.

What is the evidence for second generation antipsychotics?

Moderate to high quality evidence suggests olanzapine may be superior to aripiprazole, quetiapine, risperidone and ziprasidone for overall symptoms. Risperidone may be superior to quetiapine and ziprasidone for overall symptoms, amisulpride may be superior to risperidone for negative symptoms, and clozapine may be superior to risperidone for less drop-outs due to inefficiency.

Moderate quality evidence suggests amisulpride may be superior to ziprasidone for less drop-outs due to inefficiency, and quetiapine may be superior to clozapine for negative symptoms.

Low quality evidence is unable to determine the differences between clozapine and zotepine for overall symptoms.

March 2019

Last updated at: 10:57 pm, 22nd March 2019
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