Clinical use of antipsychotics

Shizofrenija je teški duševni poremećaj koji ima konstantnu incidenciju i prevalenciju u općoj populaciji. Značajnu ulogu u nastanku shizofrenije i drugih psihičkih poremećaja imaju poremećaji u funkciji neurotransmitorskih sustava. Za karakteristične psihotične simptome najviše je odogovoran poremećaj dopaminske neurotransmisije. Antipsihotici su lijekovi kojima je primarno djelovanje blokada dopaminskih receptora, što ublažava psihotične simptome i pomaže u uspostavljanju remisije bolesti i prevenciji relapsa. Postoji veliki broj podjela antipsihotika. Klasična podjela antipsihotika je na tipične i atipične, a odnosi se na njihov receptorski potencijal. Atipični antipsihotici ostvaruju djelovanje i na serotoninskim, histaminskim i adrenergičkim receptorima zbog čega im je spektar nuspojava drukčiji i blžţi u odnosu na tipične. Atipični antipsihotici nadalje, imaju mogućnost poboljšanja kognitivnih i afektivnih smetnji koje se učestalo javljaju u psihotičnim poremećajima. Zato, osim u liječenju psihotičnih poremećaja, antipsihotike možemo koristiti i u terapiji depresije, bipolarnog afektivnog poremećaja, poremećaja ličnosti, opsesivno-kompulzivnog poremećaja, demencija itd. Poseban oprez potreban je kod davanja antipsihotika djeci, starijima, trudnicama i bolesnicima s teškim tjelesnim oštećenjima. Kod većine spomenutih bolesnika su za terapijski učinak potrebne znatno niže doze. Antipsihotici nalaze sve širu kliničku primjenu zbog čega je poznavanje njihovog mehanizma djelovanja i nuspojava od osobite važnosti.Schizophrenia is a severe mental illness characterized by constant incidence and prevalence in the general population. The most important patophisiological mechanism for developing schizophrenia and other psychoses is a disfunction in neurotransmission, most importantly dysfunctional dopamine neurotransmission, which is responsible for the typical psychotic symptoms. Antipsychotics work primarily by blocking dopamine receptors, which attenuates psychotic symptoms and helps in establishing remission of the illness and the prevention of symptom relaps. There are a few classifications of antipsychotics and the one most commonly used is into two groups, typical and atypical, based on their receptor potential. Atypical antipsychotics block serotonin, histamine and adrenergic receptors in combination with dopamine receptors, which makes them easily tolerable for the patients due to significant decrease in the severity of their side effects in comparison to the typical ones. Moreover, atypical antipsychotics help improve cognitive and emotional disturbances which usually accompany typical symptoms of psychoses. This is why antipsychotics can be used for treatment of depression, bipolar disorder, personality disorders, OCD, dementia etc. It is important to be extremely cautious when administering antipsychotics to children, elderly, pregnant women or patients with severe physical disorders. With most of the above mentioned groups, significantly lower doses are needed to achieve the therapeutic effect. Antipsychotics are becoming more and more widely used which is why it is crucial to have knowledge of their mechanism of action and possible side effects