Antipsychotics from theory to practice: Integrating clinical and basic data

The recent introduction of the atypical antipsychotics into the treatment a rena for psychoses and related disorders comes with justifiable excitement. These newer antipsychotics offer several clinical benefits over the conven tional antipsychotics, which have been the mainstays of care thus far. The primary advantage of these atypical agents is their superior side effect pr ofiles, particularly with regard to extrapyramidal side effects (EPS). The implications from a reduction in EPS touch on virtually every aspect of pat hology in schizophrenic illness, including short- and long-term movement di sorders, negative symptoms, noncompliance, cognitive dysfunction, and dysph oria. It should be emphasized that while atypical antipsychotics share many clinical attributes, there are also substantial differences among them. Th is review will examine the pharmacology, clinical efficacy, and side effect profiles of the atypical antipsychotics and attempt to relate the attribut es observed in clinical practice and clinical trials to their basic pharmac ologic profiles. There is a fair, but not perfect, correspondence between t he pharmacologic profiles of the different atypical antipsychotics and thei r respective clinical attributes. After a comparative overview of their rec eptor-binding profiles, a brief pharmacokinetic summary will be provided. F inally, the clinical profiles of these agents will be summarized with regar d to both their efficacy and adverse effects.