The introduction of the first antipsychotic drug, chlorpromazine, was a milestone for psychiatry. The authors review the history, classification, indications, mechanism, efficacy, side effects, dosing, drug initiation, switching, and other practical issues and questions related to antipsychotics. Classifications such as first-generation/typical versus second-generation/atypical antipsychotics are neither valid nor useful; these agents should be described according to the Neuroscience-based Nomenclature (NbN). Antipsychotic drugs are not specific for treating schizophrenia. They reduce psychosis regardless of the underlying diagnosis, and they go beyond nonspecific sedation. All currently available antipsychotic drugs are dopamine blockers or dopamine partial agonists. In schizophrenia, effect sizes for relapse prevention are larger than for acute treatment. A major unresolved problem is the implausible increase in placebo response in antipsychotic drug trials over the decades. Differences in side effects, which can be objectively measured, such as weight gain, are less equivocal than differences in rating-scale-measured (subjective) efficacy. The criteria for choosing among antipsychotics are mainly pragmatic and include factors such as available formulations, metabolism, half-life, efficacy, and side effects in previous illness episodes. Plasma levels help to detect nonadherence, and once-daily dosing at night (which is possible with many antipsychotics) and long-acting injectable formulations are useful when adherence is a problem. Dose-response curves for both acute treatment and relapse prevention follow a hyperbolic pattern, with maximally efficacious average dosages for schizophrenia of around 5 mg/day risperidone equivalents. Computer apps facilitating the choice between drugs are available. Future drug development should include pharmacogenetics and focus on drugs for specific aspects of psychosis.

中文翻译：

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抗精神病药物：历史、分类、适应症、机制、疗效、副作用、剂量和临床应用的简明回顾。


第一种抗精神病药物氯丙嗪的问世是精神病学的一个里程碑。作者回顾了病史、分类、适应症、机制、疗效、副作用、剂量、药物开始、转换以及与抗精神病药相关的其他实际问题和问题。第一代/典型与第二代/非典型抗精神病药等分类既无效也没有用处;应根据基于神经科学的命名法 （NbN） 描述这些药物。抗精神病药物对治疗精神分裂症没有特异性。无论潜在诊断如何，它们都能减轻精神病，并且超越了非特异性镇静。目前所有可用的抗精神病药物都是多巴胺阻滞剂或多巴胺部分激动剂。在精神分裂症中，预防复发的效应量大于急性治疗。一个未解决的主要问题是几十年来抗精神病药物试验中安慰剂反应的难以置信的增加。可以客观测量的副作用的差异，例如体重增加，比评定量表测量（主观）疗效的差异不那么模棱两可。选择抗精神病药物的标准主要是务实的，包括可用剂型、代谢、半衰期、疗效和既往疾病发作的副作用等因素。血浆水平有助于检测不依从性，当依从性有问题时，每晚每日一次给药（许多抗精神病药都可以这样做）和长效注射制剂是有用的。急性治疗和复发预防的剂量 - 反应曲线都遵循双曲线模式，精神分裂症的最大有效平均剂量约为 5 毫克/天利培酮当量。 提供有助于药物选择的计算机应用程序。未来的药物开发应包括药物遗传学，并侧重于针对精神病特定方面的药物。