P1: FHD/GVG/GIR P2: GCR
Psychiatric Quarterly [psaq] ph129-psaq-375281 September 18, 2002 16:19 Style ﬁle version June 4th, 2002
Psychiatric Quarterly, Vol. 73, No. 4, Winter 2002 (
SAFETY AND TOLERABILITY: HOW DO
NEWER GENERATION “ATYPICAL”
Rajiv Tandon, M.D.
Previously, clinicians worked with antipsychotic drugs that almost invariably
caused extrapyramidal side effects (EPS) at the dose at which they were
clinically effective. By deﬁnition, all newer generation atypical antipsychotic
agents are signiﬁcantly better than conventional agents with regard to EPS;
i.e., they are clinically effective at doses at which they do not cause EPS. This
EPS advantage of atypical antipsychotics translates into several important
clinical beneﬁts, including better negative symptom efﬁcacy, lesser dysphoria,
less impaired cognition, and a lower risk of tardive dyskinesia; in fact, this
“EPS advantage” is the principal basis of the many clinical advantages pro-
vided by the class of atypical antipsychotics. While all atypical agents share
this “EPS advantage,” there are important differences between these agents
with regard to the ease and consistency with which this EPS advantage can
be realized. Pharmacologically, different atypical antipsychotics differ; these
differences translate into differences in their side effect proﬁles. Five atypical
antipsychotics are currently available: clozapine, risperidone, olanzapine, que-
tiapine, and ziprasidone. Meaningful differences between these agents with re-
gard to weight gain, sedation, anticholinergic side effects, cardiovascular issues,
Rajiv Tandon, M.D., is a Professor of Psychiatry at University of Michigan Medical
Center, Ann Arbor, MI.
Address correspondence to Rajiv Tandon, University of Michigan Medical Center, Ann
Arbor, MI 48109-0120; e-mail: firstname.lastname@example.org.
2002 Human Sciences Press, Inc.