Abnormal Psychology

Schizophrenia and Other Psychotic Disorders 557

dyskinesia are a by-product of schizophrenia itself, not a side effect of the medica-

tions. Other side effects of traditional antipsychotics include tremors, weight gain,

and a sense of physical restlessness.

Atypical Antipsychotics: A New Generation

More recently, a different class of medications has become available for the treat-

ment of schizophrenia: atypical antipsychotics (also referred to as second-generation

antipsychotics), which affect dopamine and serotonin and do not affect the motor

areas of the brain as much as traditional antipsychotics. Because of how they work,

they do not pose a risk of tardive dyskinesia. Examples of atypical antipsychotics

includeRisperdal(risperidone),Zyprexa(olanzapine), and Seroquel(quetiapine).

In contrast to typical antipsychotics, with long-term use these newer drugs appear

to reduce both positive and negative symptoms (Corrigan et al., in press) and may

reduce cognitive defi cits (Geddes et al., 2000; Keefe, Bollini, & Silva, 1999; Keefe

et al., 2006). However, the benefi cial effects of atypical antipsychotics on cognitive

functioning are less robust than was initially thought (Green, 2007; Keefe, Sweeney,

et al., 2007), and some studies have found that traditional antipsychotics work as

well as atypical antipsychotics for those patients who can tolerate the side effects

(Kahn et al., 2008).

Nonetheless, atypical antipsychotics have several advantages over traditional

antipsychotics: (1) As yet, they have not been found to lead to tardive dyskinesia;

(2) they can reduce comorbid symptoms of anxiety and depression (Marder, Davis, &

Chouinard, 1997); and, (3) they improve daily functioning (Keefe, Bilder, et al.,

2007). Like traditional antipsychotics, they decrease the likelihood of relapse, at

least for 1 year (which is the longest period studied; Csernansky, Mahmoud, &

Brenner, 2002; Lauriello & Bustillo, 2001). However, the benefi ts of newer antip-

sychotics must be weighed against medical costs: Side effects include changes in

metabolism that cause signifi cant weight gain and increased risk of heart problems,

and these side effects can become so severe or problematic that some people won’t

or shouldn’t continue to use these medications (McEvoy et al., 2007).

In order to compare the effects and side effects of traditional and second-generation

antipsychotic medications, NIMH funded the Clinical Antipsychotic Trials of Inter-

vention Effectiveness (CATIE) research program. This large-scale study examined

1,460 patients in 57 U.S. cites. This landmark study did not apply many of the

exclusion criteria common to previous studies typically conducted by drug compa-

nies, and thus it included a more representative sample of participants. Moreover,

the medication phase of CATIE was extended to 18 months. Analyzing the results

of the study will take years, but the most striking result thus far is the high rate of

patients who stopped taking the medication they were taking at the beginning of the

study. More than two thirds of the participants stopped, either because the medica-

tion they were taking didn’t suffi ciently help reduce symptoms or because of the side

effects. Disappointingly, continued use of second-generation antipsychotics was not

signifi cantly better overall, primarily because of their side effects (Lieberman et

al., 2005). Among these newer antipsychotics, no particular medication stood out as

superior (McEvoy et al., 2006; Tamminga, 2006).

From Madness, Episode 3, Brainwaves. BBC Worldwide Americas, Inc. From Madness, Episode 3, Brainwaves. BBC Worldwide Americas, Inc. From Madness, Episode 3, Brainwaves. BBC Worldwide Americas, Inc.

This woman is exhibiting signs of tardive

dyskinesia—involuntary lip smacking and odd

facial grimaces that can be an enduring side

effect of long-term use of traditional antipsy-

chotic medication. Such side effects can persist

even after the antipsychotic medication is dis-

continued. Symptoms of tardive dyskinesia can

be reduced with other medications.

Atypical antipsychotics

A relatively new class of antipsychotic

medications that affect dopamine and

serotonin activity but create fewer movement-

related side effects than do traditional

antipsychotics; also referred to as second-

generation antipsychotics.