Second and Third Generation Antipsychotics

About the Book

The second generation antipsychotics are a complex class of psychiatric medications, applicable to a diverse range of both FDA approved treatment indications and off-label uses. This variety stems largely from the unique pharmacodynamic profile of each agent, and often necessitates the employment of unique dosing strategies across the treatment of the varied psychiatry disorders, including schizophrenia, bipolar mania and depression, major depressive disorder, and autism. Despite the shared mechanism of dopamine D2 and serotonin-2a dual receptor blockade, which mediates the antipsychotic and antimanic properties of the second generation antipsychotics, the unique pharmacodynamic signature of each agent is subsequently responsible for the additional and varied antidepressant, anxiolytic, hypnotic, and tolerability¬ profile observed with each drug. Using an evidence based approach, this comprehensive handbook aims to highlight and discuss data relevant to treatment indications, off-labels uses, and dosing strategies of the 11 currently FDA approved second generation antipsychotics, with a strong emphasis on the pharmacodynamic profiles of these drugs. With the advent of three relatively new antipsychotics (lurasidone in 2011, brexpiprazole in 2015, and cariprazine in 2015), this text will serve as an excellent reference for practicing physicians, research investigators, and medical students alike. This review addresses not only these clinical applications, but provides physicians with the tools necessary to optimize treatment based upon patient diagnosis, proper antipsychotic selection, and implementation of an appropriate dosing strategy, thereby striking an essential balance between treatment efficacy and patient tolerability.

About the Author

Ryan Stephen O’Dell graduated from the University of Rochester in 2007 with a B.S. in Neuroscience, and a B.A. in Spanish. As an undergraduate he was involved in a four-year research project in which he investigated how the primate brain coordinates complex muscle sets to achieve delicate hand and finger movements. This research translates to advanced brain-machine interface technology for the restoration of lost neurological function. Mr. O’Dell is currently enrolled as a fourth year medical student at SUNY Upstate Medical University in Syracuse, New York, where he is finishing his final year as a candidate in the dual degree M.D./Ph.D. program. In the Department of Neuroscience and Physiology, he defended a Ph.D. thesis with honors, utilized cutting edge multiphoton live imaging techniques to elucidate the role of a specific protein (Reelin) in the dynamic properties of the emerging neurite arbor in early cortical development. He discovered that a deficiency in Reelin disrupted the stability of part of the cortical neuron that receives signals from other neurons, a part called the dendrite. Interestingly, although classically associated with lissencephaly with cerebellar hypoplasia, the neurodevelopmentally-related Reelin gene has recently been implicated as a contributor to the psychiatric disorders of autism and schizophrenia. Mr. O’Dell plans to pursue a residency in Psychiatry, with the ultimate goal of uniting his training from the lab and clinic towards both a better understanding of the precise neuropathologic mechanisms of psychiatric disorders and the development of new and more targeted therapies for said disorders. Outside of lab and classroom, Ryan enjoys ultra marathon running, having completed over 60 footraces ranging from 31 to 200 miles. Dr. Schwartz is currently professor and vice chair of psychiatry and director of all adult psychiatric clinical services at SUNY Upstate Medical University, where he also directs all medical student psychiatric training as well. Active on many committees at SUNY, he also provides direct resident supervision, lectures in several courses, and directs and organizes continuing medical education events for the psychiatry department. Dr Schwartz received his medical degree from and completed his residency in adult psychiatry at the State University of New York (SUNY) Upstate Medical University in Syracuse, New York. Dr Schwartz’s abilities as a medical educator have been recognized with the Marc H. Hollander, MD, Psychiatry Award, Teacher of the Year, and Mentor of the Year awards from SUNY Upstate Medical University; Nancy Roeske, MD, Irma Bland, Certificates of Recognition for Excellence in Medical Student and Resident Education from the American Psychiatric Association, the SUNY Upstate President’s and the SUNY Chancellor’s Award for Teaching. Dr. Schwartz is the author of Stahl’s Essential Psychopharmacology” Case Studies Volume 2, and editor of Depression: Treatment Strategies and Management, 2nd Ed., Integrating Psychotherapy and Pharmacotherapy, and Antipsychotic Drugs: Pharmacology, Side Effects and Abuse Prevention and is the Deputy Editor for the journal CNS Spectrums.