Indications

Antipsychotic drugs are used for the prophylaxis and acute treatment of psychotic illnesses including schizophrenia and psychoses associated with depression and mania. They also have an important role as an alternative or adjunct to benzodiazepines in the

* No recognised classification system exists for atypical antipsychotics.Tentative terms based on receptor binding profiles have been applied to certain drug groupings, for example'broad spectrum atypicals' for clozapine, olanzapine and quetiapine, whilst risperidone and ziprasidone have been described as 'high affinity serotonin-dopamine antagonists'. ** Amisulpride and sulpiride are structurally related. *** Sertindole is available only on a named patient basis, f Licenced indications for thioridazine were severely restricted in 2000 after evidence emerged of cardiovascular toxicity, f In some classifications thioridazine and sulpiride are considered to be 'atypical' due to their low propensity to cause extrapyramidal adverse effects.

management of the acutely disturbed patient, both for tranquillisation and sedation. Antipsychotics have been used short-term in severe anxiety but are now given only as a last resort. Certain antipsychotics have an antidepressant effect which is distinct from their ability to treat the psychosis associated with depression but use as antidepressants is difficult to justify given the many pharmacological options now available for treating depression. Antipsychotics have also proved useful in the tic disorder Tourette's syndrome and for recurrent self-harming behaviour.

The threshold for seeking specialist involvement in starting antipsychotics is much lower than that when initiating antidepressant drugs. This reflects the complexity of diagnosis of psychotic illness, its chronicity, the increased likelihood of poor compliance without appropriate support and the potential toxicity of antipsychotic agents.

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