SCHIZOPHRENIA Factsheet October 2019

What are antipsychotics? Antipsychotics are effective for the symptoms of schizophrenia. Positive symptoms include the experiences of perceptual abnormalities (hallucinations) and fixed, false, irrational beliefs (delusions). Negative symptoms include a lack of ordinary mental activities such as emotional expression, social engagement, and motivation. Antipsychotics can also cause side effects, including extrapyramidal symptoms such as dyskinesias (repetitive, NeuRA (Neuroscience involuntary, and purposeless body or facial movements), Parkinsonism (cogwheel muscle rigidity, pill-rolling Research Australia) tremor and reduced or slowed movements), akathisia (motor restlessness, especially in the legs, and resembling is one of the largest agitation), and dystonias (muscle contractions causing unusual twisting of parts of the body, most often in the independent medical neck). Other side effects include weight, hormonal and metabolic changes, sedation, and ventricular anomalies and clinical research (QTc prolongation). institutes in Australia and an international leader in neurological What is the evidence for antipsychotic effectiveness compared to placebo? research. Overall, moderate to high quality evidence shows a medium-sized effect of greater improvement in symptoms with antipsychotic medications than with placebo, with this effect staying reasonably constant over Diseases of the brain time. Effect sizes were largest in studies with smaller placebo response and in non-industry-sponsored trials. and nervous system There were also small to medium-sized improvements in quality of life and social functioning, and less all- pose the greatest health, cause discontinuation with antipsychotics, however antipsychotics produced more extrapyramidal (movement) economic and social symptoms, sedation, weight gain, prolactin increase, and QTc prolongation. burden of any disease For specific antipsychotics for symptom improvement, high quality evidence shows a large improvement group because they are with clozapine; medium-sized improvements with amisulpride, risperidone, paliperidone, zotepine, haloperidol, chronic, debilitating and quetiapine and aripiprazole; and small to medium-sized improvements with sertindole, ziprasidone, have no known cures. chlorpromazine, asenapine, lurasidone, and iloperidone. Medical research is the For specific antipsychotics' effects on weight gain, high quality evidence shows no increases with cornerstone of efforts haloperidol, ziprasidone, and lurasidone; small increases with aripiprazole, amisulpride, asenapine, and to advance the health paliperidone; and medium-sized increases with risperidone, quetiapine, sertindole, chlopromazine, iloperidone, and wellbeing of families clozapine, zotepine, and olanzapine. For specific antipsychotics' effects on prolactin concentration levels, there and the community. Our were no increases with aripiprazole, quetiapine, asenapine, chlorpromazine, or iloperidone; small increases with dedicated scientists ziprasidone and lurasidone; medium-sized increases with sertindole and haloperidol; and large increases with are focussed on risperidone and paliperidone. For specific antipsychotics' effects on QTc prolongation, there were no increases transforming their with lurasidone, aripiprazole, paliperidone, or asenapine; small increases with haloperidol, quetiapine, olanzapine, research into significant risperidone, and iloperidone; medium-sized increases with ziprasidone, and amisulpride; and a large increase and practical with sertindole. For specific antipsychotics' effects on extrapyramidal symptoms, moderate quality evidence benefits for all patients. shows a small decrease with clozapine; no increases with sertindole, olanzapine, quetiapine, aripiprazole, While we hope you find iloperidone, amisulpride, and asenapine; small increases with ziprasidone, paliperidone, and risperidone; and this information useful, medium-sized increases with lurasidone, chlorpromazine, zotepine, and haloperidol. For specific antipsychotics' it is always important to effects on sedation, there were no increases with amisulpride, paliperidone, sertindole, and iloperidone; medium discuss any questions to large increases with aripiprazole, lurasidone, risperidone, haloperidol, asenapine, olanzapine, quetiapine, and about schizophrenia or ziprasidone; and large increases with chlorpromazine, zotepine and clozapine. its treatment with your doctor or other health care provider. For more information see the technical table

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