Antipsychotic drugs are divided into two general groups. The older first generation drugs are called typical, traditional, or conventional antipsychotic medications. They were once referred to as neuro-leptics, a term derived from the neurological features of their side effects. Neuroleptic means “grabbing or taking hold of neurons.”

Their use is limited to only 10 percent of the market today. The more commonly prescribed, newer medications are called atypical or novel antipsychotic drugs or second generation antipsychotics. These newer drugs have shown treatment benefits beyond their antipsychotic effects, including treatment of bipolar disorder. Consequently, some doctors refer to them as broad spectrum psychotropics. Psychotropics are drugs that affect the mind. This term more accurately reflects the ability of newer medications to serve as more than just antipsychotics.

Typical Antipsychotic Drugs

The first antipsychotic drugs, now more than half a century old, brought about a revolution in psychiatry due to their ability to decrease the severity of schizophrenia's symptoms. Early studies compared the drugs to already available sedatives. Despite the presence of some unwanted side effects, they represented a real breakthrough in treatment. For the first time, patients could realistically look forward to the hope of escaping from their delusions and hallucinations. These typical antipsychotics could also control disorders of thought that plagued patients with schizophrenia.

Effectiveness of Older Antipsychotic Medications

The American Psychiatric Association's Guidelines for treatment of patients with schizophrenia summarized several studies on the efficacy of first generation antipsychotics in the acute phase of treatment. These studies found that approximately 60 percent of patients treated for six weeks improved to the extent of complete remission or experienced only mild symptoms, compared to only 20 percent of patients treated with a placebo.

Table 9-1: Typical or Conventional Antipsychotic Medications

Trade or Brand Name	Generic Name
Haldol	haloperidol
Loxitane	loxapine
Mellaril	thioridazine
Moban, Lidone	molindone
Navane	thiothixene
Orap	pimozide
Serentil	mesoridazine
Thorazine	chlorpromazine
Trilafon	perphenazine
Permitil, Prolixin	fluphenazine
Stelazine	trifluoperazine
Taractan	chlorprothixene
Vesprin	triflupromazine

Sources: Medications for Mental Illness, The Essential Guide to Psychiatric Drugs, and The Complete Family Guide to Schizophrenia.

Forty percent of patients treated with typical antipsychotic medications continued to show moderate to severe symptoms, compared to 80 percent of patients treated with a placebo. Only 8 percent of patients treated with these medications showed no improvement or a worsening of symptoms, compared to nearly 50 percent of placebo-treated patients.

It appears that all first-generation antipsychotics are equally effective. If a patient had responded to a given medication in the past, he was likely to respond to the same medication again.

Like all medications, older antipsychotic drugs have side effects. The more serious ones will be discussed later in this chapter, but the following list should give you a basic idea of what to expect.