New antipsychotics: the present status

Until antipsychotics can be subdivided according to differentiated effects on psychic functions (for example on positive/negative symptoms and cognitive functions), the best classification seems to be one based upon receptor-binding profiles and the side effects that follow. Such a combined pharmacological-clinical approach appears fruitful to clinicians as well as pharmacologists. According to this classification the new antipsychotics can be subdivided into three main categories: the relatively pure dopamine antagonists (D2 antagonists, including sulpiride and amisulpiride); the dopamine (D2)-serotonin (5-HT2)-norepinephrine (alpha 1) antagonists (risperidone, ziprazidone and sertindole); and the multireceptor antagonists (clozapine, olanzapine and seroquel). Clozapine is still the most potent antipsychotic and the least potent at inducing extrapyramidal symptoms. New drugs such as olanzapine, seroquel and sertindole represent the further development of clozapine's positive qualities, while risperidone and ziprasidone are dominated to a greater extent by relatively traditional dopamine D2 receptor blockade.