First-Generation (Conventional, Typical) Antipsychotics | Second-Generation Antipsychotics | Side Effects of Antipsychotic Drugs
Before the second-generation (atypical) antipsychotics, with
their superior side-effect profiles, became available, first-generation
antipsychotics (FGAs; sometimes called conventional or typical antipsychotics),
especially haloperidol, were the mainstay of treatment of late-life
agitation. Extrapyramidal side effects (EPS), however, are common
with haloperidol, especially in the elderly, limiting its usefulness.
Tardive dyskinesia, a late-appearing EPS, develops more rapidly
and at lower antipsychotic doses in elderly patients than in younger
ones (Caligiuri et al. 1999; Jeste et al. 1999; Karson et al. 1990; Lieberman et al. 1984; Saltz et al. 1989). Tardive dyskinesia is also more common in patients
with evidence of cortical atrophy and in dementia patients (Sweet and Pollock 1992). When antipsychotics are discontinued,
tardive dyskinesia symptoms are less likely to disappear in older
patients than in younger adults (Smith and Baldessarini 1980; Yassa et al. 1984), although the symptoms may not increase in severity
(Yassa et al. 1992). These concerns regarding tardive
dyskinesia and other EPS have contributed to the switch in clinical
preference for the newer antipsychotic drugs.