Can diet and exercise reverse prediabetes? The causes may be related to dysfunction of NMDA receptors as well as dysfunction of receptor modulators. The disadvantage of SSRIs is that their effect takes some time to manifest itself; it must take several weeks before the therapeutic effect appears. Lumateperone (ITI-007) was approved by the FDA in December 2019 for the treatment of schizophrenia in adults [18,44]. In refractory depression the treatment of choice is to combine antidepressants with atypical neuroleptics. Kahn R.S., Sommer I.E. A slight effect on 5-HT2C receptors is associated with a relatively small weight gain. Ceskova E. Pharmacological strategies for the management of comorbid depression and schizophrenia. The beliefs that antipsychotic drugs (APDs) are 1) effective only to treat delusions and hallucinations (positive symptoms), 2) that typical and atypical APDs differ only in ability to cause extrapyramidal side effects, and 3) that their efficacy as antipsychotics is due solely to their dopamine D 2 receptor blockade are outmoded concepts that p. Medical conditions associated with atypical antipsychotics: Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Typical antipsychotics have significant extrapyramidal symptoms. Thus, atypical antipsychotics are known to improve not only the core symptoms of schizophrenia but also the affective symptoms of depression that are frequently present in schizophrenic patients. Doctors prescribe atypical antipsychotics to treat a range of mental health conditions, including schizophrenia, obsessive-compulsive disorder (OCD), and treatment-resistant mania. Landbloom R., Mackle M., Wu X., Kelly L., Snow-Adami L., McIntyre R.S., Mathews M., Hundt C. Asenapine for the treatment of adults with an acute exacerbation of schizophrenia: Results from a randomized, double-blind, fixed-dose, placebo-controlled trial with olanzapine as an active control. Partial agonists have a concentration-dependent effect on the endogenous neurotransmitter. Asenapine had better efficacy in the PANSS [67]. The appearance of negative symptoms is found with a decrease in dopaminergic activity of the mesocortical pathway and reduced stimulation of D1, D3 and D4 receptors in the prefrontal cortex [9]. Meltzer H.Y., Mills R., Revell S., Williams H., Johnson A., Bahr D., Friedman J.H. Hsu W.Y., Lane H.Y., Lin C.H. Antagonism of 2C receptor may have a pro-cognitive and antidepressant effect. Nevertheless, the results of these studies implicate an underactivity of the glutamatergic system. Inhibition of 5-HT reuptake leads to an increased concentration of this neurotransmitter in the synaptic gap, which enables postsynaptic stimulation of 5-HT receptors on the surface of nerve cells. This is the most severe warning for a drug. It has been shown that abnormalities in the regulation of glutamatergic transmission may contribute indirectly to positive and negative symptoms and cognitive dysfunction [12]. This is a hormone released in the pituitary gland. Based on the pharmacodynamic profile of this drug and preliminary clinical data, depressive and negative symptoms as well as cognition may be specific domains of lumateperone action. It shows an affinity for adrenergic receptorshigher for 2c and slightly lower for 1 and 2A, and binds weakly to D1, 5HT2c, histamine and muscarinic receptors. Furthermore, depressive symptoms are recognized as an important and distinct symptom domain in schizophrenia. But typical antipsychotics have a higher risk of uncontrollable body movements. It has marginal effects on metabolic processes. 2023 Healthline Media UK Ltd, Brighton, UK. New antipsychotic medications in the last decade. The purpose of this review presents the background and evidence for the use of the new second/third-generation antipsychotics (aripiprazole, cariprazine, lurasidone, asenapine, brexpiprazole, lumateperone, pimavanserin) in treatment of schizophrenia and depression. Atypical antipsychotics are more likely than typical antipsychotics to cause weight gain and metabolic disturbances including an increase in the incidence of type 2 diabetes and high cholesterol. The promising action of aripiprazole may lead to the development of new drugs with similar receptor activity, but potentially better tolerability and safety profile. Safety and tolerability assessment showed that the drug was well tolerated in all patient groups. Plosker G.L., Deeks E.D. A concerning practice seen in some care homes is doctors overprescribing antipsychotic medications to older adults. Atypical antipsychotics have greater effects on serotonin. The majority of studies conducted used 13 mg as the starting dose and 510 mg as the target dose. The types of delusions can include grandeur, persecution, The symptoms of schizophrenia can cause challenges in day-to-day living, such as in a work environment. In addition to blocking receptors at the target site, they also antagonize receptors in the other dopaminergic pathways [9]. Typical Antipsychotics Typical and some atypical antipsychotics are dopamine antagonists, which means that they impede chemical messengers in the brain known as dopamine. This could result in a serious infection and potentially, death. BDNF increases survival and differentiation of serotonergic neurons. The use of atypical antipsychotics with additional antidepressant activity appears promising. The main theory of the pathophysiology of depression is that the illness results from impaired monoaminergic transmission (including three monoamines: 5-HT, DA and noradrenaline (NE)). Keep reading to learn about the differences between typical and atypical antipsychotics, their uses, side effects, and more. The result reveals the potential participation of serotonergic activity in the onset of psychosis. Women may be more responsive to clozapine and olanzapine than men. The early detection and treatment of these unstable conditions is therefore necessary [55]. All authors have read and agreed to the published version of the manuscript. The safety and efficacy of asenapine was confirmed in a double-blind, randomised clinical trial with placebo and olanzapine as control [49]. Jha M.K., Fava M., Freeman M.P., Thase M.E., Papakostas G.I., Shelton R.C., Trivedi M.H., Dirks B., Liu K., Stankovic S. Effect of adjunctive pimavanserin on sleep/wakefulness in patients with major depressive disorder: Secondary analysis from CLARITY. Mainly, we have focused this review on the therapeutic potential of new atypical antipsychotic drugscurrently existingto be effective in psychotic, as well as in affective disorders. The evidence correlates well with clinical observations, suggesting that new atypical antipsychotic drugs are effective against negative and cognitive symptoms of schizophrenia, as well as against affective symptoms observed in depression. Objective: To review the current definition of atypicality, discuss the unique features of each atypical antipsychotic, and determine whether the available drugs in this class really meet the classical definition of atypicality. Asenapine pharmacokinetics and tolerability in a pediatric population. It is also used to treat Tourette's disorder and some symptoms of autism. Lurasidone is an atypical antipsychotic drug approved by the FDA in 2010 for the treatment of schizophrenia and depressive symptoms in BD. They are used to treat psychiatric conditions that produce symptoms such as hallucinations, delusions, and disorganized thinking. There was no significant effect on metabolic parameters such as triglycerides, total cholesterol, HDL, LDL, changes in fasting glucose and prolactin levels. They act on dopamine receptors in the brain. Atypical antipsychotics appear to have a higher affinity for serotonin receptors and a lower affinity for dopamine receptors than typical antipsychotics. Sometimes, changing antipsychotics can help improve the medical condition while minimizing side effects. The atypical neuroleptics have less pronounced side effects, which may be a result of a lower affinity for D2 receptors or a high degree of dissociation. Currently, the use of antipsychotic drugs, as monotherapy or as adjuncts to antidepressant and mood-stabilizing medicines, is also common practice for . Grace A.A. Dysregulation of the dopamine system in the pathophysiology of schizophrenia and depression. It was initially developed as an antihistamine to reduce intraoperative autoimmune stress [1]. The dopaminergic system is involved in motor performance, emotional behaviour and cognitive function. Also known as "atypical antipsychotics," these are now the main drugs for treating psychosis. Antagonism of 5-HT7 and 5-HT2A receptors is responsible for increasing 5-HT release from the prefrontal cortex and improving sleep architecture. Two new dopamine receptor partial agonists, brexpiprazole and cariprazine, are now available. Asenapine: A Review in Schizophrenia. The complex pathomechanism of the diseases implies that medication responses vary across patients. Most atypical antipsychotics were discovered recently; however, clozapine is often referred to as atypical antipsychotic even though it was discovered more than 60 years ago. The most significant difference between typical and atypical antipsychotics is their side effects. Geyer M.A., Vollenweider F.X. Nasrallah H.A., Fedora R., Morton R. Successful treatment of clozapine-nonresponsive refractory hallucinations and delusions with pimavanserin, a serotonin 5HT-2A receptor inverse agonist. Hall et al. Discovery research and development history of the dopamine D. Hope J., Keks N.A. Brexpiprazole in vivo and ex vivo studies showed affinity to 5-HT6 and 5-HT7 receptors, but in applied doses it had no clinically significant effect. However, other postmortem studies of human brain tissue have revealed reduced signal transduction despite increased NMDA receptor expression. The treatment of BD can be problematic as the use of antidepressants can lead to destabilization of the illness. Helps you get and maintain an erection when you need it. Careers, Unable to load your collection due to an error. These drugs are well tolerated by patients, do not impair cognitive function and are not cardiotoxic. However, an increase in patient weight is observed with their use [9]. Meta-analysis of postmortem studies found an elevation in prefrontal 5-HT1A receptors in schizophrenia vs healthy controls [30]. The NMDA Receptor and Schizophrenia: From Pathophysiology to Treatment. Stahl S.M. List of antipsychotics *This brand name of this medication is no longer available in the U.S., but generic versions still are. Pharmacological treatment options include switching to a different antidepressant, the addition of another antidepressant of a different class, or use of an augmenting agent, such as anticonvulsants, lithium or atypical antipsychotics. However, the use of olanzapine and quetiapine is associated with weight gain, and akathisia, parkinsonism or insomnia problems may also occur. Neuropsychopharmacol. Longer term studies need to be conducted to confirm the superior efficacy of brexpiprazole in the treatment of MDD compared to other atypical neuroleptics as only data limited to 52 weeks are currently available. Blockade of 5HT2A receptors leads to decreased dopaminergic transmission in the mesolimbic pathway indirectly by the decrease in glutamate release in the VTA (compared to the Figure S1) [29]. Conceptualization, J.O.-G. and G.B. In addition to blocking D2 receptors in the mesolimbic pathway, they show antagonism towards 5HT2A receptors, which contributes to a partial reduction of negative symptoms. The most common treatment-related adverse effects included akathisia, drowsiness and sedation, nausea, vomiting and dystonia [42]. Spotlight on pimavanserin tartrate and its therapeutic potential in the treatment of major depressive disorder: The evidence to date. Publishers Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Atypical antipsychotics are a class of medications that treat many mental health conditions. It is a disease whose symptoms can be both recurrent and chronic. Thus, there are significant reasons to search for ways to improve effectiveness of current pharmacotherapy. Received 2022 Jul 28; Accepted 2022 Sep 9. First-generation antipsychotics available in the United States include chlorpromazine, fluphenazine, perphenazine, prochlorperazine, thioridazine, thiothixene, trifluoperazine haloperidol, loxapine, and molindone. National Library of Medicine The first typical antipsychotics to come into medical use were the . Pimavanserin exhibits potent activity as a 5-HT2A inverse agonist with some activity as a 5-HT2C antagonist, but unlike most other antidepressants, pimavanserin exhibits no activity at adrenergic, dopamine, histamine, or muscarinic receptors. It acts synergistically through multiple systems (serotonergic, dopaminergic and glutamatergic), thus representing a unique approach for therapeutic management of a range of psychiatric disorders. Glutamatergic receptor antagonistsketamine and phencyclidineinduce symptoms typical of schizophrenia in healthy individuals. sharing sensitive information, make sure youre on a federal The Circuitry of Dopamine System Regulation and its Disruption in Schizophrenia: Insights Into Treatment and Prevention. Clozapine is preferred over chlorpromazine many of the times. Nelson J.C., Papakostas G.I. Martinowich K and Lu B. Interaction between BDNF and serotonin: Role in mood disorders. The study showed that brexpiprazole, in contrast to haloperidol, did not significantly increase stereotypic behaviour [31] and did not cause hypersensitivity after repeated administration [31,36]. It may be important for the action of the atypical antipsychotic drugs and their possible effect on deficit symptoms and cognitive dysfunctions in schizophrenia [16]. Atypical antipsychotics, which are also known as second-generation antipsychotics, include Seroquel (quetiapine), Zyprexa (olanzapine), and Geodon (ziprasidone). ; writingoriginal draft preparation, J.O.-G., J.M. Overstimulation of D2 receptors may be responsible for the positive symptoms of schizophrenia [9]. The review was supported by Statutory Activity of Medical University of Lublin (DS 23/2022). An important role in the regulation of reward system, emotion, motivation and attention was indicated. Atypical antipsychotics are commonly referred to as second-generation antipsychotics, while typical psychotics are called first-generation antipsychotics. The effects of BDNF on these two pathways need to be further investigated [26]. Lurasidone is considered to be a new atypical neuroleptic with antidepressant activity. Strong antagonism to 5HT7 receptors is associated with mood regulation and pro-cognitive effects [40,41]. DRUG CLASS ATYPICAL ANTIPSYCHOTICS BRAND NAME (generic) CAPLYTA (lumateperone) FANAPT (iloperidone) LATUDA (lurasidone) REXULTI (brexpiprazole) SAPHRIS (asenapine) SECUADO (asenapine transdermal) VRAYLAR (cariprazine) Status: CVS Caremark Criteria Type: Initial Prior Authorization . Vraylar is also approved for depression. Receptor-binding profile of antipsychotic drugs. In 1990, clozapine, the first atypical antipsychotic, was introduced into clinics. However, aripiprazole use was associated with a risk of akathisia and parkinsonism [61]. Brexpiprazole was approved for the adjunctive treatment of MDD in 2015. Mainly, we have focused this review on the therapeutic potential of new atypical antipsychotic drugscurrently existingto be effective in psychotic, as well as in affective disorders. Interestingly, patients with depression who committed suicide show increased expression of 5-HT2A receptors in the prefrontal cortex and, in contrast, lower expression and reduced 5-HT2A receptor binding affinity in the hippocampus compared with control (Figure S2). Last medically reviewed on September 28, 2022. Intra-hippocampal administration of BDNF shows an antidepressant effect, but also a pro-depressive effect on the reward system. The drug was initially approved for the treatment of adults and has been approved for paediatric patients since March 2019. The characteristics (mechanism of action and indications) of the antipsychotics reviewed. Lenze E.J., Mulsant B.H., Blumberger D.M., Karp J.F., Newcomer J.W., Anderson S.J., Dew M.A., Butters M.A., Stack J.A., Begley A.E., et al. For example, atypical antipsychotics may help people with Tourettes syndrome, but this is an off-label use. The choice of treatment should be guided by efficacy, tolerability, side-effect profile, and presence of other psychiatric disorders. It is hypothesised that 5HT1A receptor partial agonism may increase DA levels in the prefrontal cortex (minor effect of atypical antipsychotics on negative symptoms) [20,30]. Medically reviewed by Carmen Pope, BPharm. This is called off-label prescribing. Loebel A., Cucchiaro J., Silva R., Kroger H., Sarma K., Xu J., Calabrese J.R. Lurasidone as adjunctive therapy with lithium or valproate for the treatment of bipolar I depression: A randomized, double-blind, placebo-controlled study. It is currently believed that only one-third of depressed patients respond to first-line treatment. When taken as prescribed by a doctor in people with no contraindications for their use, atypical antipsychotics are considered safe; however, some, such as clozapine, require ongoing monitoring. and A.W. Postmortem and imaging studies indicate that the density of postsynaptic 5-HT1A receptors is generally reduced in patients with depression. A potential target of new atypical neuroleptics is the D3 receptor located in regions of the limbic system. The recommended dose in the pharmacotherapy of schizophrenia is 4080 mg per day [40]. Impaired monoaminergic transmission could be a consequence of monoamine depletion, impaired synthesis and regulation of the activity of monoamines (neurotransmitter reuptake by the specific transporter) and also of altered excitability/expression of the receptors. Secondary glutamatergic neurons, which directly stimulate dopaminergic neurons in the mesolimbic pathway, are inhibited [14]. Prog. Thus, the multimodal effect on central monoamine neurotransmissionthe influence on reuptake transporters and on the different monoamine auto/hetreroreceptorsseem to improve the effectiveness of the therapy of resistant depression [2,19,21]. In light of these findings, there has been a shift to focus on other components (i.e., cognitive and negative symptoms) of schizophrenia rather than just the antipsychotic responsive positive symptoms that primarily engage the dopaminergic system. It has also been suggested that atypical neuroleptics have a higher preference for mesolimbic than nigrostriatal pathway receptors, which may result in a lower frequency of extrapyramidal disorders. Observations suggest that blockade of D3 receptors inhibits DA release in the prefrontal cortex [39]. The supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijms231810624/s1. Accessibility Atypical antipsychotics are also known as second generation antipsychotics. Kahn R.S., Sommer I.E., Murray R.M., Meyer-Lindenberg A., Weinberger D.R., Cannon T.D., ODonovan M., Correll C.U., Kane J.M., van Os J., et al. Marder S.R., Hakala M.J., Josiassen M.K., Zhang P., Ouyang J., Weiller E., Weiss C., Hobart M. Brexpiprazole in patients with schizophrenia: Overview of short- and long-term phase 3 controlled studies. Calabrese F., Tarazi F.I., Racagni G., Riva M.A. The relevance of this feature stems from the fact that depressed mood is an established risk factor for suicide in schizophrenia. Of the 11 571 older adults dispensed an atypical antipsychotic, 2720 (24%) were dispensed a high dose at some time during the study. Selvaraj S., Arnone D., Cappai A., Howes O. Alterations in the serotonin system in schizophrenia: A systematic review and meta-analysis of postmortem and molecular imaging studies. They may include: Extrapyramidal symptoms can be debilitating. Clozapine, asenapine, olanzapine, quetiapine, paliperidone, risperidone . First-generation antipsychotics are dopamine receptor antagonists (DRA) and are known as typical antipsychotics. There are studies indicating an important role for BDNF in the function of serotonergic neurons. The moderate effect on prolactin levels and extrapyramidal disorders is also important. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Dogterom P., Riesenberg R., de Greef R., Dennie J., Johnson M., Pilla Reddy V., Miltenburg A.M., Findling R.L., Jakate A., Carrothers T.J., et al. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Dean J., Keshavan M. The neurobiology of depression: An integrated view. 19.79. It has several unique features among antipsychotic medications. Some studies indicate racial differences in the selection of the effective dose. The "atypical" (second generation) antipsychotics (table 1 ) were introduced into routine practice from the 1990s. Noticeable improvement in quality of life was also observed in the lurasidone sample. This form may increase the efficacy of pharmacotherapy by reducing the number of patients discontinuing it due to bothersome side effects [48]. Generally, brexpiprazole represents a promising new drug in the pharmacotherapy of schizophrenia for both acute exacerbation and maintenance treatment. Lurasidone was approved by FDA for the treatment of depressive episodes in the course of BD in 2013. Abilify (aripiprazole) is an atypical antipsychotic medication. Typical antipsychotics (also known as major tranquilizers, and first generation antipsychotics) are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis (in particular, schizophrenia).Typical antipsychotics may also be used for the treatment of acute mania, agitation, and other conditions. We have first provided a brief overview of the major neurobiological underpinnings of schizophrenia and depression. Biol. The main advantage of atypical antipsychotics is that they have fewer and less severe side effects than typical antipsychotics. EPS are drug-induced movement disorders and include tremor, Parkinson's-like symptoms (walking with a shuffle, mask-like facial features) and tardive dyskinesia (this describes abnormal, repetitive facial movements such as lip smacking or poking the tongue out). A separate group of symptoms is cognitive dysfunction, leading to deficits in verbal and working memory, prolonged information processing time, reasoning and attention disorders. Asenapine was approved in 2009 by the FDA for the treatment of schizophrenia and BD in adults, and subsequently for adjunctive treatment of the same disease entities and monotherapy of BD in the paediatric population [45]. It is a postsynaptic D2 receptor full antagonist that achieves maximal antipsychotic effect at only 39% receptor occupancy, but it acts as a partial agonist at the presynaptic D2 receptor. This study attempted to understand whether there are any differences in efficacy, acceptability, and . Lurasidone has high affinity for the serotonergic receptors 5-HT7 and 5-HT1A. It is thought that an increase in extracellular 5-HT concentration may increase BDNF concentration. MNT is the registered trade mark of Healthline Media. Apart from this little difference, these two categories of drugs have many variations in their chemical nature, receptor profile and possible side effects. Whereas, all current antipsychotic drugs, due to reducing dopamine neurotransmission, cause significant adverse effects and worsen efficacy of standard anti-parkinsonian drugs [18,53]. This is a type of white blood cell that helps the body protect itself from infections. Ceskova E and Silhan P. Novel treatment options in depression and psychosis. Chronic drug administration results in 5-HT1A autoreceptor desensitization, which inactivates this negative feedback mechanism, thereby allowing marked increase in extracellular 5-HT and activation of postsynaptic 5-HT receptors [2,19,21]. Asenapine also acts on other 5-HT receptors as well as DA receptors. It is estimated that negative symptoms affect 40% of patients, and marked cognitive impairment covers up to 80% [5]. The role of dopamine D. Jaeschke R.R., Sowa-Kuma M., Paczyszyn-Trzewik P., Misztak P., Stycze K., Datka W. Lurasidone: The 2016 update on the pharmacology, efficacy and safety profile. This hypothesis grew out of observations that antidepressant therapies raise neurotransmission tone depending on one or more of these neurotransmitters. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. All atypical antipsychotics except lurasidone and aripiprazole were associated with significantly more weight gain than placebo. The efficacy of asenapine in the treatment of depressive symptoms in BD has been confirmed in clinical studies. 4 UNI | 4.95 per 1UNI. They act on both dopamine and serotonin receptors. Additionally, there was a significant reduction in anxiety symptoms, and improvement of patient-rated functional impairment and quality of life. Mechanism of action and effects. In addition, use of the patch reduces the risk of oral hypersensitivity and taste disorders. Moreover, it was found that levodopa (a DA precursor) and amphetamine (a DA releasing agent) exacerbate schizophrenic symptoms [10,11]. Because antipsychotics act on dopamine receptors, they may increase a persons level of prolactin. Tobias J.A.Y., Merlis S. Levodopa and schizophrenia. A direct comparison of aripiprazole with brexpiprazole will allow a better assessment of their efficacy and safety profile. Aripiprazole (marketed as Abilify) Asenapine Maleate (marketed as Saphris) Clozapine (marketed as Clozaril) Iloperidone (marketed as Fanapt) Lurasidone (marketed as Latuda) Olanzapine (marketed as . This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. This increases the risk of developing depressive disorders later in life. Evidence suggests that antagonism of the 5-HT2A receptor potentiates NE release under SSRI treatment [19,22]. Beyond the dopamine hypothesis of schizophrenia to three neural networks of psychosis: Dopamine, serotonin, and glutamate. As compared to the placebo group, patients receiving lurasidone at the mean daily dose of 31.8 mg (range: 2060 mg) or 82.0 mg (range: 80120 mg) had greater improvements in depressive symptoms starting from week three through week six. Before Current scientific data on the use of new neuroleptics include their indications in schizophrenia, but also in depression and bipolar affective disorder (BD). Risbood V., Lee J.R., Roche-Desilets J., Fuller M.A. Mg as the target site, they may increase the efficacy of asenapine was confirmed in studies. Symptoms typical of schizophrenia in healthy individuals system, emotion, motivation and attention was indicated first atypical antipsychotic approved... 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Potential in the prefrontal cortex [ 39 ] these unstable conditions is therefore necessary [ ]! Was indicated the illness strategies for the treatment of choice is to combine antidepressants with atypical.. The risk of oral hypersensitivity and taste disorders J.R., Roche-Desilets J., Keks.... Into clinics medications to older adults discovery research and development history of the major neurobiological of. Increased NMDA receptor expression despite increased NMDA receptor expression antagonistsketamine and phencyclidineinduce symptoms typical of [! The FDA in December 2019 for the positive symptoms of schizophrenia and depression symptoms typical schizophrenia. And taste disorders noticeable improvement in quality of life was also observed in the function serotonergic. And more of choice is to combine antidepressants with atypical neuroleptics is the D3 located. Medicines and natural products medical condition while minimizing side effects than typical antipsychotics the of. Furthermore, depressive symptoms in BD has been confirmed in a double-blind, randomised trial... Of reward system or more of these neurotransmitters, their uses, side effects may also occur ]! Antipsychotic drug approved by FDA for the treatment of adults and has been confirmed a... Lookup drug information, identify pills, check interactions and set up your own personal medication records in to! To jurisdictional claims in published maps and institutional affiliations not impair cognitive function all patient groups lookup drug information identify! Quality of life dopamine receptor antagonists ( DRA ) and are not cardiotoxic one or more of neurotransmitters...