Atypical vs. Typical Antipsychotics

Atypical antipsychotics are also called second-generation antipsychotics (SGAs). They’re a newer class of medications that work differently in your body than previous (first-generation or typical) antipsychotics. Both help to regulate neurotransmitters, chemicals in your body that allow neurons to signal to each other.

Studies have found that the brains of people with schizophrenia are more sensitive to the neurotransmitters dopamine, serotonin, and glutamate. High or low dopamine levels can lead to hallucinations and disordered thinking.

While typical antipsychotics (FGAs) block dopamine in the brain, SGAs block both dopamine and serotonin. This results in some key differences.

The most significant difference is that SGAs are less likely to cause extrapyramidal symptoms. These are movement disorders that are common and serious side effects of FGAs. Some of these side effects can become permanent.

Both types of antipsychotics work to treat positive symptoms of schizophrenia, such as hallucinations and delusions. But SGAs may also help treat negative symptoms, like decreased pleasure or lack of motivation.

Common Atypical Antipsychotics taken:

  • Aripiprazole (Abilify) can be prescribed for adults and adolescents ages 13 and up. You can take it as an injectable solution available through a healthcare professional, or in one of four oral forms:
    • tablet
    • oral solution
    • Abilify Discmelt, an orally disintegrating tablet
    • Abilify MyCite, a tablet with a patch sensor that lets your doctor know you’ve taken the drug
  • Aripiprazole lauroxil (Aristada) is a prodrug, which means it’s inactive until a chemical reaction in your body changes it into aripiprazole. It also requires a medical professional to administer an injection.
  • Asenapine maleate (Saphris) is unique in that it’s available as both a tablet and a patch. Studies show that it’s particularly good at preventing relapse. The FDA has approved its use for children older than 10 to treat bipolar disorder, but not schizophreniaTrusted Source.
  • Brexipiprazole (Rexulti) treats schizophrenia and depression. Doctors usually prescribe it as a once-daily tablet. A generic form is not yet available.
  • Cariprazine (Vraylar) is FDA-approved to treat schizophrenia and bipolar I disorder. It can take a long time to build up in your body and to leave your system. If you stop taking it, you might still feel its effects for up to 4 weeks.
  • Clozapine (Clozaril) is the oldest SGA and remains the “gold standard” for those with treatment-resistant schizophrenia. The FDA has approved its use for reducing suicidal behavior in people with schizophrenia. It’s available as a tablet, an orally disintegrating tablet (Fazaclo), and an oral suspension (Versacloz). Clozapine is not FDA-approved to treat schizophrenia in children or adolescents, but some doctors prescribe it off-label.
  • Iloperidone (Fanapt) is a twice-daily tablet that can treat both positive and negative symptoms of schizophrenia. It can cause serious problems, such as stroke or even death, in older adults with dementia.
  • Lumateperone (Caplyta) is approved to treat schizophrenia and depressive episodes of bipolar disorder. It can increase suicidal thoughts in adults ages 18-24. The FDA has not approved it for pediatric use.
  • Lurasidone (Latuda) is a once-daily tablet that doctors can prescribe for people ages 13 and older. A 2020 study found that lurasidone continued to reduce schizophrenia symptoms in adolescents for the full 2 years of the study.
  • Olanzapine (Zyprexa) is another drug used to treat schizophrenia or bipolar I disorder. It’s available as a tablet, orally disintegrating tablet, or long-acting injectable administered by a healthcare professional. This is one of the atypical antipsychotics that the FDA has approved for adolescents. It can cause serious side effects, such as drug reaction with eosinophilia and systemic symptoms (DRESS).
  • Paliperidone (Invega) is derived from a different drug, risperidone. It comes in different forms, including extended-release tablets and long-acting injectables with different brand names. Paliperidone is approved to treat schizophrenia in children ages 12 and older, but it could have broader potential.
  • Quetiapine (Seroquel) is available in an immediate-release tablet that you take two or three times a day, or an extended-release tablet that you take once daily. It’s the least likelyTrusted Source of the SGAs to cause extrapyramidal symptoms. It’s also FDA-approved for treating schizophrenia in adolescents.
  • Risperidone (Risperdal, Perseris) is one of the earliest SGAs and is the most commonly used SGA among children. Doctors prescribe it for children as young as 5 years to treat irritability associated with autism, but it’s only approved for treating schizophrenia in children 13 years and older. It comes in four forms:
    • regular tablet
    • orally disintegrating tablet
    • oral solution
    • injectable administered by a healthcare professional
  • Ziprasidone (Geodon) is available as a twice-daily capsule, or you can have a healthcare professional give you an immediate-release injection.

Side Effects of Antipsychotics:

All atypicals carry a risk of mild to severe side effects. These side effects differ from person to person and drug to drug.

Some common side effects include:

  • sedation
  • dizziness
  • low blood pressure when standing up (orthostatic hypotension)
  • significant weight gain
  • metabolic syndrome
  • diabetes
  • hypertension
  • abnormal cholesterol
  • heart disease
  • complications in the third trimester of pregnancy
  • suicidal thoughts and behaviors

With some SGAs, extrapyramidal symptoms may still occur, especially at high doses.

It’s important that you take care of your physical health while using antipsychotics. SGAs can cause you to gain weight or worsen overweight or obesity if you already have it, leading to other chronic conditions.

You may also become resistant to your medication, so it’s important to stay in touch with your healthcare team and keep them updated if your medicine stops working.

Finally, be sure to continue your medication, even if you feel better. Suddenly stopping the medication can cause problems and may increase your risk of a relapse of symptoms.

Schizoaffective Disorder: What are Hallucinations?

Hallucinations are a psychotic symptom of schizoaffective disorder. People experiencing hallucinations may hear, see, smell, taste or feel things that aren’t really there, and which other people can’t hear, see, smell, taste or feel.

Auditory hallucinations are the most common type of hallucination. They are mostly experienced as voices. To a person with schizoaffective disorder, these voices sound just like people speaking to them, and people with the illness cannot differentiate between what is real – for example a friend speaking to them – and what is a hallucination.

Voices might be heard in the second person – for example someone saying “you stink”, “you’re ugly”, “they hate you”. Sometimes voices might command a person to do something – by saying, for example, “jump off the bridge”, “take an overdose”. People with schizoaffective disorder may also have third person hallucinations, which commonly take the form of two or more voices talking among themselves or commenting on the person’s behaviour. Third person hallucinations are common in both schizoaffective disorder and schizophrenia, but are seen less frequently in bipolar disorder.

In most cases the experience of auditory hallucinations in the form of voices is unpleasant. Voices are frequently accusatory, reminding the person of past misdeeds, some imaginary, and some real. However, in a minority of cases, voices can be pleasant or even helpful.

In addition to voices, auditory hallucinations can involve noises, such as buzzing, screeching and ringing. Additionally, people with schizoaffective disorder may think that their own thoughts are being broadcast, or can be heard by other people. They may also think that other people’s thoughts are being forced into their own minds, or that their thoughts have been stolen from their heads.

Hallucinations of all five senses may be experienced. In addition to auditory hallucinations, people may have tactile hallucinations – such as feeling as though you are being pushed, touched or held down – visual hallucinations – such as seeing things that aren’t there or feeling that colours are brighter than they should be – hallucinations of smell and hallucinations of taste.

Visual hallucinations occur much less frequently than auditory hallucinations, and are more common in conjunction with auditory hallucinations – for example seeing and hearing someone who no one else can see. Hallucinations of smell and taste are more unusual and tend to focus on things tasting or smelling different than usual. This can lead to people with schizoaffective disorder thinking that their family and friends are trying to poison them.

Sources: Schizoaffective Disorder Simplified

On Schizoaffective Disorder

On Schizoaffective Disorder & Hallucinations:

“I awoke, went to drink a glass of water and walked back toward my room. I stopped dead in my tracks. My room was red and four cloaked figures floated above my bed with fire circling around them. Inside of the cloaks was a black abyss and I knew they had come for me. As long as I stayed out of my room they wouldn’t see me. I stared at them for what seemed like an hour before they went away. I slept on the couch that night.”

~ Thomas Wallingford, The Mighty Contributor

#MentalHealth #SchizoaffectiveDisorder #Hallucinations #EndStigma

Schizophrenia and Breakthrough Symptoms

This seems like a good time to discuss breakthrough symptoms of schizophrenia. This is not easy for me to admit, but important if I want people to understand what it’s like to have a psychotic disorder.

“People can be on the best psychotropic medication targeting a mental health disorder and still experience disruptive and paralysing symptoms. These breakthrough symptoms can be voices, delusions, paranoia, anxiety, or perhaps even depressive features that go unchallenged and uncontrolled by medication. Breakthrough symptoms can be very disturbing, and demoralising, due to the chronic, sporadic, and their seemingly unpredictable nature. This type of symptom activation can be triggered by something external.”

~ psychreg.org

I’ve been feeling numb for a few weeks now and hoping to control it through positive coping strategies such as increased meditation as I did not want to go through a med change of increasing my antipsychotic medication.

It didn’t work and this past week breakthrough symptoms of thought broadcasting and thought insertion which drives my paranoia continued rising to the level of needing a change. After consultation with my psychiatrist I’ve increased my antipsychotics, anti-anxiety medications and one on my antidepressants which is a noradrenergic and specific serotonergic antidepressant (NaSSA) and encourages sleep, i.e. drowsiness is one of it’s side effects.

My breakthrough symptoms can best be summed up as more invasive auditory hallucinations, paranoia and delusions that people can read my mind and insert thoughts into my head against my will. At this time I realize it is just a delusion and not real. If I didn’t make the med change it wouldn’t be long before I believed my delusions despite all evidence to the contrary which would probably require hospitalization. The med change will probably take a couple of weeks until I am completely back at my baseline. It’ll be an interesting couple of weeks, but this is part of the reality of living with a severe mental illness.

#MySchizLife #BreakthroughSymptoms #PsychoticDisorders

Age 16, 1988

Age 16, 1988

For me my mental illness came crashing into my life in full force when I was sixteen.

That was the year I first started hearing voices,

started to believe people could read my mind and insert thoughts into my head,

was the first time I was truly suicidal,

was the year I started to self harm,

dragging a razor blade across my left arm and watching my blood flow,

the first time I was dissociative,

when the world became vague, dreamlike, less real,

as I observed events as if from outside my body like a movie in slow motion,

the year the panic attacks began.

This was also the year I suffered as a survivor of sexual assault,

the most difficult event of my life as a biker held a knife to my throat and raped me,

beating me severely.

From then on I carried a knife in case I am in a similar situation,

not so I could defend myself, but so I could slit my wrists.

To this day the sound of a Harley Davidson makes me physically cringe.

That was when the night terrors began reliving my trauma every time I closed my eyes.

That was the year the negative coping mechanisms developed: cutting, isolating, alcohol, drugs.

That was when the abyss of depression swallowed me up whole,

and I wanted to die or crawl in a hole forever,

because I was worthless, pathetic, weak, and most importantly,

I was to blame for being raped,

I should have been able to stop it as a sixteen year old boy.

This is not how it should be at sixteen.

My Voices, My Dear

When you are gone

I shudder in the corner of my existence

They point at me

I stand strong to the accusations

Then they laugh

I wilt into the corner

Through the walls and through the floors

Alone

Alone without them

Without you.

Crisscrossing

The crisscrossing clash of tiny dishes fall about my feet

As an echo bounces off the walls of my own sweating intolerance

My palms have become cold

While the heat of my frustrations boils to the surface

I repress the tears rolling down my face

Pulling them back inside me if I only had the patience

The slam of the door silences your exit

And I slouch into the floorboards alone

Alone at last.