Antipsychotics for Schizophrenia and Bipolar Disorder: An Introduction

 Medication Management

Mental health disorders, especially diagnoses such as schizophrenia and bipolar disorder with psychotic features, are a leading cause of disability and poor health worldwide.1-7 The National Institute of Mental Health reports that both schizophrenia and bipolar disorder type 1 have a lifetime prevalence of approximately 1% each.6-8

When treating psychotic disorders, medication management is the mainstay of therapy, particularly antipsychotics. There are two categories of antipsychotics:

  • first-generation antipsychotics (FGAs), also called typical antipsychotics
  • second-generation antipsychotics (SGAs), also called atypical antipsychotics

See more details in our antipsychotic primer.

Efficacy and tolerability of these medications depends on the degree of dopamine D2 blockade and other receptor activity.9 Data from positron emission tomography “indicate that D2 occupancy levels ranging from 65% to 80% elicit optimal antipsychotic effects” with adverse effects, especially extrapyramidal symptoms (EPS), occurring at 80% or more dopamine receptor occupancy.9

Antipsychotic Side Effect Profiles and Treatment Adherence

While efficacious in improving symptoms related to psychosis, about 20% to 50% of people with schizophrenia or other psychotic disorders may suspend medication usage, leading to detrimental effects in their prognosis.4 This suspension or discontinuation of treatment typically occurs due to the patient’s intolerance to the medication based on their side effect profiles. When managing patients on antipsychotics, it is important to find a medication that helps control symptoms of their mental illness while also being cognizant of the side effect profiles and how to manage them.

The following literature review analyzes five recently published papers on emerging pharmacological treatment options, including the newly approved medication olanzapine and samidorphan, as well as current medication management strategies to overcome unfavorable side effect profiles for patients with schizophrenia and bipolar disorder. Commentary and clinical takeaways are provided.

Papers included in the Literature Review:

  1. Goff DC. The Pharmacologic Treatment of Schizophrenia-2021. JAMA. 2021.
    View the takeaways
  2. Carli M, Kolachalam S, Longoni B, et al. Atypical Antipsychotics and Metabolic Syndrome: From Molecular Mechanisms to Clinical Differences. Pharmaceuticals (Basel). 2021.
    View the takeaways
  3. Nash A, Kingstone T, Farooq S, et al. Switching Antipsychotics to Support the Physical Health of People with Severe Mental Illness: A Qualitative Study of Healthcare Professionals’ Perspectives. BMJ Open. 2021.
    View the takeaways
  4. Foster A, King J. Antipsychotic Polypharmacy. Focus (Am Psychiatr Publ). 2020.
    View the takeaways
  5. Correll CU, Newcomer JW, Silverman B, et al. Effects of Olanzapine Combined With Samidorphan on Weight Gain in Schizophrenia: A 24-Week Phase 3 Study. Am J Psychiatry. 2020.
    View the takeaways
Last Updated: Sep 1, 2021