Many of those who, for health reasons, had to cross the threshold of a psychiatric office leave it holding in their hands several prescriptions for intricate drugs. The need to take psychotropic medications is often scary. Fears of side effects, addiction, or changes in one’s personality - all this introduces a seed of doubt and mistrust in medical recommendations. As sad as it may be, sometimes the main healers become numerous friends, relatives and neighbors on the landing, and not a certified specialist.

One of the groups of drugs widely used in psychiatry are antipsychotics. If you have been prescribed antipsychotics, get ready to hear a lot of cliched phrases about their “capabilities”. The most typical are:

• neuroleptics turn a person into a “vegetable”;
• psychotropic drugs “stifle the psyche”;
• psychotropic drugs destroy personality;
• they cause dementia;
• Because of the antipsychotics, you will die in a mental hospital.

The reason for the emergence of such myths is speculation due to a lack of reliable information or the inability to understand it correctly. At all times of the existence of “homo sapiens,” any incomprehensible phenomena were explained by myths and fables. Remember how our distant ancestors explained the change of day and night, eclipses.

In any case, do not rush to panic! Try to approach the problem of antipsychotics from the point of view of evidence-based medicine.

More about neuroleptics

What are neuroleptics?

Neuroleptics are a large group of drugs used in the treatment mental disorders. The greatest value of these drugs is their ability to fight psychosis, hence the second name - antipsychotics. Before the advent of neuroleptics, poisonous and narcotic plants, lithium, bromine, and coma therapy were widely used in psychiatry. The discovery of Aminazine in 1950 marked the beginning of a new stage in the development of all psychiatry. Treatment methods psychiatric patients have become much more gentle, and cases long-term remissions have become more frequent.

Classification of antipsychotics

All antipsychotics are usually classified into two groups:

1. Typical neuroleptics. Classical antipsychotic drugs. Against the background of high therapeutic possibilities have enough high probability development of side effects. Representatives: Aminazine, Haloperidol, etc.
2. Atypical neuroleptics. Modern drugs, the distinctive ability of which is a significantly reduced likelihood of developing and severity of side effects, primarily neurological. These include: Clozapine, Rispolept, Quetiapine, Olanzapine.

Almost every year new antipsychotics appear on the pharmacological market. Drugs are becoming more effective, safer and more expensive.

How do antipsychotics work?

The mechanism of action of antipsychotics is to reduce the speed of transmission of brain impulses. This is achieved by inhibiting a substance that transmits nerve impulses in some of the brain cells, called dopamine. Most antipsychotics are quickly broken down and eliminated from the body. There are long-acting drugs, capable of providing healing effect lasting up to a month. For example, Haloperidol decanoate or Clopixol depot, a solution of which is administered intramuscularly. The use of long-acting medications is very convenient, because patients often forget to follow the recommendations and take pills. Unfortunately, almost all existing drugs of this type are typical antipsychotics, which means they are inferior in safety to many atypical antipsychotics.

Indications for the use of neuroleptics

When can a doctor recommend taking antipsychotics? Not all mental disorders require the use of antipsychotics. Considering their exceptional ability to affect delusions, hallucinations, agitation and abnormal behavior, this group of drugs is indispensable in the treatment of psychosis. of different origins. The ability of antipsychotics to relieve symptoms of fear, anxiety and agitation allows them to be used quite effectively in anxiety, phobic and depressive disorders. In some cases, antipsychotics can replace tranquilizers, long-term use of which is unacceptable.

Antipsychotics are designed to combat the following symptoms:

• psychomotor agitation;
• aggressive and dangerous behavior;
• delusions and hallucinations;
• pronounced feeling of fear;
• tension in the body;
• mood swings;
• apathy and lethargy with;
• poor sleep;
• vomit.

As you can see, the possible range of use of antipsychotics is quite wide, and is not limited exclusively to severe mental disorders.

Side effects of antipsychotics

All medicines, to one degree or another, in addition to therapeutic effects have a number of unwanted side effects. There is an opinion that herbal preparations are completely safe. This is not entirely true. Thus, long-term use of lemon balm also causes dizziness, and excessive use of chamomile decoctions causes. Even a single overdose of celandine in some cases ends in toxic hepatitis.

The likelihood of side effects and their severity depends on many factors:

• individual sensitivity to the drug;
• the dose used and duration of treatment;
• method of administration of the drug and its interaction with other drugs;
• the patient's age, his general condition health.

The main side effects of antipsychotics include:

• Neuroleptic syndrome. The cause of its appearance is extrapyramidal disorders. Muscle tone increases, movements become slow and constrained, and slurred speech is possible. Patients may be bothered by restlessness in place. If a patient develops neuroleptic syndrome, the doctor will prescribe correctors - drugs that remove the symptoms of neurolepsy.
• Endocrine disorders. Occurs with long-term use of large doses of antipsychotics.
• Drowsiness. Typical antipsychotics are more effective. Often drowsiness goes away 3-4 days after starting treatment with antipsychotics.
• Changes in appetite and body weight. Many patients, especially women, are most afraid of weight gain. It should be understood that the mere presence of a mental disorder does not predispose to ideal figure. Depression, for example, in many cases significantly changes body weight, either down or up, which is mistakenly attributed to the effects of medications.

Less common side effects include: temporary disturbances of the visual organs, digestive organs (diarrhea, constipation), difficulty urinating and autonomic disorders.

What does a patient taking antipsychotics need to know?

At the very beginning of a course of treatment with antipsychotics, patients may be faced not only with the manifestation of their side effects, but also with the obligation to comply with the rules for taking the drugs. The first weeks will be difficult for both the patient and the doctor. After all, you have to choose the right drug and a sufficient dose. Only mutual trust, responsibility and an impeccable desire for results will allow a successful course of treatment with antipsychotics. The patient must cooperate in every possible way with the treatment, follow the recommendations and report any changes in his condition.

Some simple tips taking antipsychotics:

• Follow the indicated dosage and frequency of taking the medications. Trying to adjust the dose on your own will only worsen the condition.
• Avoid alcoholic drinks, even beer. Neuroleptics interact extremely poorly with alcohol; taking them together can cause an exacerbation of the disease.
• Since antipsychotics slow down the reaction rate, you will have to wait a while with driving and other mechanisms.
• Eat well. Eat foods rich in vitamins and protein.
• Drink enough fluids. However, it is not advisable to use strong tea and coffee.
• Be sure to do morning exercises. Even the minimum physical activity will be useful.
• Discuss all questions about treatment with your doctor, not with grandmothers at the entrance.

The correct use of antipsychotics allows you to cope with many unpleasant consequences mental disorders, improve the quality of life and give a chance for recovery. Regularly appearing modern drugs minimize the development of side effects, allowing for safe treatment long time. Don't be afraid to take antipsychotics and stay healthy!

What drugs are antipsychotics? To modern medicines that help patients with psychotic disorders. Prescribed and used when various syndromes– from psychosis to full-blown mental illness. Not all of them are dispensed by pharmacists without a doctor’s prescription, so we present antipsychotics a list of drugs without prescriptions.

What is a neuroleptic?

These are drugs that can help treat mental illness. Available in three forms, but less often - in drops. You can buy it in pharmacies in any CIS country: Ukraine, Belarus, Russia and others. Patients are afraid, although the truth about over-the-counter antipsychotics is that they rarely provoke negative impact.

Effect of antipsychotic drugs

What effect do neuroleptics have? The drugs calm, reducing external mental impact, relieve tension, reduce feelings of aggression and fear. Antipsychotics relieve the symptoms of people with mental disorders, in the treatment of schizophrenia, help get rid of obsessive thoughts, calm down. Most antipsychotics are divided into two groups: long-acting tranquilizers and antidepressants; a group of prescription antipsychotics. According to the classification, they are divided into typical and atypical drugs. Wikipedia divides the list of antipsychotics with a prescription according to the active substance into:

1. Thioxanthenes;
2. Phenothiazines;
3. Benzodiazepines;
4. Barbiturates.

Mode of action of neuroleptics

Neuroleptic cause an antipsychotic effect: they extinguish nervousness, weaken psychosis. The side effects of the drugs are not dangerous if taken with care. For recovery, a consultation with the attending physician is required, who will re-prescribe the antipsychotic used with or without a prescription.

Pharmacokinetics

Mechanism of action: antipsychotropic medications affect the dopamine structures of the brain, blocking access to them, which provokes endocrine disorders and lactation. Prescription antipsychotics have a short half-life. Once ingested, the drugs do not act for long, although there are over-the-counter antipsychotics with an increased, prolonged duration. Prescription antipsychotics can be prescribed in pairs: one to stimulate the other. Additionally, it is recommended to use anti-depressant drugs, primarily of an antipsychotic nature.

Indications for use

Important! Prescription antipsychotics are indicated for use in paranoid disorders and chronic somatoform disorders with pain. The most common active ingredients: thioxanthene, phenothiazine.

The primary purpose of the drug is the standard dose that determines therapeutic symptoms. The amount of the drug taken starts at a high level, gradually decreasing. As a result, the dose is 1/4 of the original and continues to prevent relapse. Daily doses of the drug are individual, so the initial and final doses are different. Anti-relapse therapy is carried out with long-acting ones. Prescription antipsychotics are administered into the body through injections or IVs, the exact method depends on the person. Secondary administration, for maintenance, occurs orally: antipsychotics without a prescription in tablet or capsule form.

List of the most effective drugs produced without a doctor's prescription:

"Propazine" is an antipsychotic without a prescription. Medical drug serves as an anti-anxiety agent, relieves anxiety, slows down movements. Used for various types of phobias and somatic disorders. Tablets 25 mg, take two or three daily, sometimes the dose is increased to six. Small doses are unable to cause side effects.

Teralen is a prescription antipsychotic. Produces antihistamine and neuroleptic effects. Along with Propazine, it has a sedative effect, with various psychoses caused by infectious diseases. This prescription antipsychotic, due to its mild effect, is the only one on the list used for children, and is recommended for allergy sufferers and people with dermatological diseases. The daily dose of the drug is 25 mg. Maybe intramuscular injection in the form of a half percent solution.

The prescription drug Thioridazine is used when you need sedation. Unlike analogues, it does not provoke fatigue. The medicine is effective in treating emotional disorders and helps overcome fear. When treating states borderline with psychosis, 70 +/- 30 mg per day is prescribed. In other cases: neuralgic anxiety, gastrointestinal dysfunction or cardiovascular system caused by neurosis, they are prescribed to be taken two to three times every day. The dose depends on the disease and the patient’s body. Range daily dose ranged between 5 and 25 mg. Psycholeptic, need a prescription.

An antipsychotic without a prescription, Triftazin helps in the treatment of depression, relieves hallucinations, and protects the body from delusional and obsessive ideas. By stimulating the body, the antipsychotic effect helps treat atypical conditions that are characterized by obsessive syndromes. As therapy, Triftazin is combined with other substances, either tranquilizers or sleeping pills antidepressants. The daily dose of an over-the-counter antipsychotic is similar to Etaperazine - 20, sometimes 25 mg.

"Fluanxol" is an antipsychotic without a prescription. Protects against depression, stimulates the body with an anti-delusional effect. For ongoing treatment of emotional disorders, 1/2 to 3 mg daily is prescribed - the most small dose on the list. For the treatment of mental illness, hallucinations and schizophrenia, 3 mg per day is prescribed. The least common on the list causes drowsiness.

The non-prescription antipsychotic “Chlorprothixene” is intended to provide sedative and antipsychotic effects, and stimulates the functioning of the sleeping pill. It is considered an anxiolytic - a tranquilizer. The main area of ​​application is patients with obsessive worries and phobias. Chlorprothixene is taken after meals three times a day, single dose varies from 5 to 15 mg. This is the only nighttime drug on the list because it improves sleep.

"Etaperazine" is an antipsychotic without a prescription. It is a means of combating psychotic disorders associated with apathy. Affects areas of the brain responsible for reluctance to perform actions. Etaperazine is a potent means of combating neuroses that cause phobias and anxiety. Instructions for use recommend taking up to 20 mg per day.

Inexpensive drugs without a prescription are not presented because they have weak impact. The following are available without a prescription: Chlorprothixene, Propazine, Etaperazine, Thioridazine, Fluanxol. Despite this, before using non-prescription drugs, consultation with a specialist is required. Thioridazine is an over-the-counter anxiolytic, and is not the strongest of the antipsychotics.

Side effects of drugs

Incorrect use of antipsychotics without a prescription is the main provocateur of side effects. Long-term use sometimes provokes the disorders presented in the list:

• Muscle nerves that cause spontaneous sudden movements in different directions. Acceleration of movement. Additional drugs - tranquilizers - help calm this condition. From the list appears most often;
• Disorder of the nerve endings of the facial muscles. This causes involuntary movement of the eyes and muscle structures of the face, causing the person to grimace. Why is such a process dangerous? Facial expression may not return to normal state, and then remain with the patient until death. The side effect is typical of typical over-the-counter antipsychotics;
• Intensive treatment with antipsychotics without a prescription develops or worsens depression due to its effects on the nervous system. Depression reduces the treatment received, weakens the effect of sleeping pills;
• Antipsychotic drugs have an effect on the gastrointestinal tract, which causes corresponding side effects - heartburn, nausea.
• Some substances in the composition have a negative effect on the organs of vision in case of overdose.

Atypical are the new generation of drugs that do not act on dopamine receptors, causing rest. This is caused by an effect on the body's serotonin receptors. Atypical prescription antipsychotics have less effect on the brain, being more of a daytime antidepressant than a treatment for mental disorders. New generation drugs have almost no side effects. Atypical drugs cannot be called cheap.

The presented list highlights common atypicalities:

Olanzapine, an over-the-counter antipsychotic, is the only one on the list used to combat catatonia - involuntary movements. It has side effects - they can be taken for a long time, but this upsets the endocrine system and causes obesity. Among other things, it is the strongest of those presented, therefore it tops the list of antipsychotics without prescriptions.

The non-prescription drug Clozapine is similar in its work to many typical drugs from the list above - it has a sedative effect, but protects the body from depression. The range of use of tablets is for hallucinations and obsessions. Has an anti-delirium effect. One from the list is shown to children over 5 years old.

Risperidone is an over-the-counter antipsychotic that is widely used in practice. The composition of the substance combines all the positive effects characteristic of those presented above: it protects against cataleptogenic symptoms, hallucinations, delusional and obsessive thoughts. It is not yet known whether it helps with childhood neuroses.

"Rispolept-Consta" is a long-acting, non-prescription antipsychotic. Normalizes, sometimes restores the previous state of health. Possessing long period half-life, stays in the body for a long time, which helps fight paranoid syndromes. Quite an expensive antipsychotic without a prescription among the list.

The non-prescription antipsychotic “Quetiapine” acts on both types of receptors, protecting the body from paranoid and manic syndromes, struggles with hallucinations. Slightly relieves depression, but strongly stimulates. For the same thing, you need “Amitriptyline”, not included in the list, but its analogue.

The non-prescription antipsychotic "Ariprizole" has an effect on psychosis and is good for the therapeutic treatment of schizophrenia. It is considered the safest on the list.

"Serdolect" is similar in effect to Ariprizole. Along with the latter, this non-prescription antipsychotic restores cognitive functions and is mainly used in the treatment of apathy. Sertindole is contraindicated in patients on the heart list.

The drug "Invega" is an alternative to Aripiprazole, protecting and restoring the body in schizophrenia. It is listed as “by prescription”.

"Eglonil" is on the list atypical antipsychotics without a prescription, although many mistakenly classify it as typical. Serves to restore the operation of the central nervous system, has an effect on depression, helps fight apathy symptoms. The only psychoanaleptic on the list. It is highly recommended that Eglonil be used in patients with depression due to somatic problems: allergic reactions and migraines. Used to treat problems with the gastrointestinal tract. Approved for use together with sedative antidepressants.

In the presented list of atypical antipsychotics without a prescription, only Invega is available with a prescription. Each over-the-counter drug is a daily use. Allowed for retail atypical drugs are sold in any pharmacies. In Russia, the price depends on the drug, ranging from 100 to several thousand rubles.

What is the best drug after a stroke?

After a stroke for recovery after emotional disorder prefer to prescribe atypical drugs, such as clozapine. In the post-painful period, you can stop taking prescription antipsychotics if feeling good.

Side effects of atypical antipsychotics

How atypical drugs work: The way some drugs work causes neurolepsy and has negative impact on endocrine structures. These factors cause obesity and bulimia.

Attention! Pharmacists, having conducted research, say with confidence: atypical neuroleptics without a prescription are little better than regular ones. Because of this, they are prescribed only in the absence of a positive effect of typical antipsychotic drugs. Any side effects that arise are resolved by correctors.

Withdrawal syndrome

Most non-prescription antipsychotics that affect the psyche can be addictive. Unexpected withdrawal of medication causes aggression, develops depression, reduces nervous stability - a person quickly loses patience and begins to cry easily. Additionally, side effects may occur from taking antipsychotics without a prescription. Antipsychotic withdrawal syndrome has common features with drug cessation. The patient experiences bone aches, migraines, constant lack of sleep due to insomnia, and possible problems with the gastrointestinal tract: nausea, vomiting. From the psychological point of view, the patient is afraid to return to depressive state due to refusal to take the drug, for which you need to be able to correctly stop using antipsychotics without a prescription.

Important! A doctor will help you get off psychotropic and antipsychotropic medications without a prescription.

Using antipsychotics without a prescription can cause problems; only an experienced doctor can correctly assess the problem and prescribe the right treatment. The doctor will tell you how to take it and how to reduce the amount of the drug you take. At the end of taking prescription antipsychotics, antidepressants are additionally prescribed, which will support mood and mental state at a good level.

Neuroleptic or neuroblockers are drugs, usually with a prescription, that help normalize mental disorders, bringing a person’s nervous states back to normal. Be sure to follow your doctor's instructions regarding taking medications - this will help avoid side effects. Although the prices are high, many antipsychotics are sold without a prescription.

Biopsychosocial model of schizophrenia

The approach to the treatment of mental disorders is determined by the level of knowledge about their origin and development mechanisms. This lecture presents the role of different components of therapy on the path to overcoming mental illness.
Currently, the most productive approach to considering a mental illness such as schizophrenia is recognized by most professionals around the world as the biopsychosocial model. "Bio" means that the biological characteristics of the body - the functioning of brain systems and metabolism in it - play a large role in the development of this disease. These biological features predetermine the next component - some features of the psyche both during its development in childhood and functioning in adulthood.

It has been shown that patients with schizophrenia have features of functioning nerve cells brain, the transmitter of information between which is the neurotransmitter dopamine (“neuro” means a nerve cell, “mediator” means a transmitter, intermediary).

The system of neurons, the exchange of information between which occurs thanks to the dopamine molecule, is called the dopamine neurotransmitter system. Dopamine in right moment time, it is released from the nerve ending of one cell and, once in the space between two cells, finds special areas (so-called dopamine receptors) on the process of another - neighboring cell, to which it attaches. In this way, information is transferred from one brain cell to another.

There are several subsystems in the dopamine system of the brain. One is responsible for the functioning of the cerebral cortex, the other, extrapyramidal, for muscle tone, and the third for the production of hormones in the pituitary gland.

"Psycho" indicates the psychological characteristics of a person that make him more vulnerable than others to the effects of various stressors (circumstances that cause a state of stress in a person, i.e. a physiological and psychological adaptation reaction, or a reaction to maintain balance). Such a greater vulnerability than others means that even those circumstances that other people can overcome painlessly can cause a painful reaction in these highly vulnerable people. Such a reaction may result in the development of psychosis. They talk about individually reduced stress resistance of these people, i.e. decreased ability to respond to stress without developing a disease state.

Examples are well known from practice when such events as moving from class to class, from school to school, infatuation with a classmate or classmate, graduation from school or college, i.e. events that are frequent in the lives of most people become “triggers” in the development of schizophrenia in people predisposed to this disease. We are talking about the role in the development of the disease social factors that a person encounters when interacting with other people. An indication of the role of social circumstances that become stressful for vulnerable people is contained in the term “biopsychosocial” component of the model.

From the above, it becomes obvious that help for people suffering from schizophrenia should consist of attempts to influence all three components involved in the development of the disease and, very importantly, supporting this disease.

In modern psychiatry, assistance to people suffering from schizophrenia consists of: 1) drug treatment (with the help of medications), which is aimed at normalizing the functioning of the dopamine system of nerve cells in the brain and, as a consequence, increasing stress resistance; 2) psychological treatment , i.e. psychotherapy aimed at correcting those psychological characteristics that contributed to the development of the disease, psychotherapy aimed at developing the ability to cope with the symptoms of the disease, as well as psychotherapy aimed at creating obstacles to the psychological consequences of the disease, for example, detachment from other people; 3) social measures aimed at maintaining the functioning of a person in society - support in maintaining the patient’s professional status, social activity, training his social interaction skills, taking into account social requirements and norms, as well as measures that would help normalize interaction with loved ones. The last component involves not only helping the patient himself, but also working with the social environment, in particular with family members, who, not least of all, need help and support.

Neuroleptics: main and side effects

The main group of medicinal psychotropic drugs effective in helping people suffering from schizophrenia is the group antipsychotics.

Psychotropic are drugs that affect brain activity and normalize mental functions (perception, thinking, memory, etc.). There are several groups of psychotropic drugs that affect primarily the disturbance of one or another mental function: antipsychotics (drugs that can suppress delusions, hallucinations and other productive symptoms), antidepressants (increasing low mood), tranquilizers (reducing anxiety), mood stabilizers (mood stabilizers) , antiepileptic, or anticonvulsants, drugs, nootropics and metabolic drugs (improving metabolism in the nerve cells themselves).

The main pharmacological effect of antipsychotics is the blocking of dopamine receptors, which results in the normalization of the activity of the dopamine system of brain cells, namely a decrease in this activity to an optimal level. Clinically, i.e. at the level of symptoms of the disease, this corresponds to a noticeable decrease or complete disappearance of the productive symptoms of the disease (delusions, hallucinations, catatonic symptoms, agitation, attacks of aggression). The ability of antipsychotics to suppress completely or partially such manifestations of psychosis as delusions, hallucinations, and catatonic symptoms is called antipsychotic action.

In addition to antipsychotic, neuroleptics also have a number of other effects:

· calming (sedative), which allows the use of antipsychotics to reduce internal tension, attacks of agitation and even aggression;

· sleeping pills, with an important advantage of antipsychotics as sleeping pills is that, unlike tranquilizers, they do not cause complications such as the formation of mental and physical dependence, and after normalization of sleep they can be canceled without any consequences;

· activating, i.e. the ability of some antipsychotics to reduce inactivity;

· normothymic (stabilizing background mood), especially characteristic of the so-called atypical neuroleptics (see below), which, due to the presence of this effect, can be used to prevent the next attack of schizophrenia or schizoaffective psychosis or reduce its severity;

· “behaviour-correcting” effect - the ability of some antipsychotics to smooth out behavioral disorders (for example, painful conflict, the desire to run away from home, etc.) and normalize desires (food, sexual);

· antidepressant, i.e. ability to improve mood;

· antimanic - the ability to normalize pathologically elevated, elevated mood;

· improvement of cognitive (cognitive) mental functions- the ability to normalize the thinking process, increase its consistency and productivity;

vegetostabilizing (stabilization vegetative functions- sweating, heart rate, blood pressure level, etc.).

These effects are associated with the influence of antipsychotics not only on dopamine, but also on other systems of nerve cells in the brain, in particular on the norepinephrine and serotonin systems, in which the transmitter of information between cells is norepinephrine or serotonin, respectively.

Table 1 presents the main effects of antipsychotics and lists drugs that have these properties.

Side effects are also associated with the effect of antipsychotics on the dopamine system of nerve cells in the brain, i.e. unwanted effects. This is an opportunity to simultaneously influence muscle tone or change some parameters while providing an antipsychotic effect. hormonal regulation(for example, the menstrual cycle).

When prescribing antipsychotics, their effect on muscle tone is always taken into account. These effects are undesirable (side effects). Since muscle tone is regulated by the extrapyramidal system of the brain, they are called extrapyramidal side effects. Unfortunately, most often the effect of neuroleptics on muscle tone cannot be avoided, but this effect can be corrected with the help of cyclodol (Parcopan), Akineton and a number of other drugs (for example, tranquilizers), which in this case are called correctors. To successfully select therapy, it is important to be able to recognize these side effects.

Table 1
Main effects of antipsychotics

	Classic or typical neuroleptics	Atypical antipsychotics and new generation drugs
Antipsychotic	Haloperidol Majeptyl Trifluoperazine (triftazine, stelazine) Etaperazine Moditen depot Chlorprothixene Clopixol Fluanxol	Azaleptin (leponex) Zyprexa Rispolept (speridan, risset) Seroquel Abilify
Sedative	Aminazine Tizercin Haloperidol Clopixol Etaperazine Trifluoperazine (triphthazine, stelazine)	Azaleptin Zyprexa Seroquel
Hypnotic	Tizercin Aminazine Chlorprothixene Thioridazine (Sonapax)	Azaleptin Seroquel
Activating	Frenolon Majeptyl Fluanxol	Rispolept (speridan, risset)
Normothymic	Clopixol Fluanxol	Azaleptin Risperpet Seroquel
"Correcting behavior"	Thioridazine (Sonapax) Neuleptil Piportil	Azaleptin Seroquel
Antidepressant	Trifluoperazine (triftazine, stelazine) Chlorprothixene Fluanxol	Rispolept (speridan, risset) Seroquel
Antimanic	Haloperidol Tizercin Thioridazine (Sonapax) Clopixol	Azaleptin Zyprexa Rispolept (speridan, risset) Seroquel
Improvement of cognitive functions	Etaperazine	Azaleptin Zyprexa Seroquel Rispolept (speridan, risset)
Vegetostabilizing	Etaperazine Frenolon Sonapax

The effect of antipsychotics on muscle tone may manifest itself differently during the stages of therapy. So, in the first days or weeks of taking antipsychotics, the development of so-called muscular dystonia is possible. This is a spasm in one or another muscle group, most often in the muscles of the mouth, oculomotor muscles or neck muscles. Spastic muscle contractions can be unpleasant, but can be easily eliminated with any corrector.

With longer use of antipsychotics, the development of phenomena may occur drug-induced parkinsonism: tremors in the limbs (tremors), muscle stiffness, including stiffness of the facial muscles, stiff gait. When the initial symptoms of this side effect occur, the feeling in your legs ("cotton legs") may change. Opposite sensations may also appear: feelings of anxiety with a constant desire to change the position of the body, the need to move, walk, move your legs. Subjectively initial manifestations This side effect is experienced as discomfort in the legs, a desire to stretch, and a feeling of “restless legs.” This type of extrapyramidal side effect is called akathisia, or restlessness.

With many months, and more often many years of taking antipsychotics, it is possible to develop tardive dyskinesia, which is manifested by involuntary movements in one or another group of muscles (usually the muscles of the mouth). The origin and mechanism of this side effect is being actively studied. There is evidence that its development is facilitated by sudden changes in the regimen of taking antipsychotics - sudden breaks, withdrawal of drugs, which is accompanied by sharp fluctuations concentration of the drug in the blood. Table 2 shows the main manifestations of extrapyramidal side effects and tardive dyskinesia and measures to eliminate them.

The start of taking correctors to reduce the severity of extrapyramidal side effects may coincide with the time of prescription of the antipsychotic, but may also be postponed until such effects appear. The corrector dose required to prevent the development of extrapyramidal side effects is individual and selected empirically. Usually it ranges from 2 to 6 tablets of cyclodol or akineton per day, but not more than 9 tablets per day. A further increase in their dose does not enhance the corrective effect, but is associated with the likelihood of side effects of the corrector itself (for example, dry mouth, constipation). Practice shows that not all people experience extrapyramidal side effects of antipsychotics and that not all cases require their correction during the course of treatment with antipsychotics. In approximately two-thirds of patients taking antipsychotics for more than 4-6 months, the dose of the corrector can be reduced (and in some cases even canceled), and no extrapyramidal side effects are observed. This is explained by the fact that with sufficiently long-term use of antipsychotics in the brain, compensatory mechanisms for maintaining muscle tone are activated and the need for correctors decreases or disappears.

Table 2
Main neurological side effects of antipsychotic therapy and methods for their correction

Side effect	Main manifestations
Muscular dystonia (first days, weeks)	Spasm in the muscles of the mouth, eyes, neck	Cyclodol or Akineton 1-2 tablets. under the tongue Any tranquilizer (phenazepam, nozepam, elenium, etc.) 1 table. under the tongue Phenobarbital (or 40-60 drops of Corvalol or Valocordin) Caffeine (strong tea or coffee) Ascorbic acid up to 1.0 g orally in solution Piracetam 2-3 capsules orally
Drug-induced parkinsonism (first weeks, months)	Tremor, muscle stiffness, greasiness of skin	Cyclodol (Parcopan) or Akineton: 3-6 tables per day, but not more than 9 tablets. up to 3 tables per day
Akathisia (first weeks, months)	Restlessness, restlessness, desire to move, restless legs feeling	up to 30 mg per day Tranquilizer (phenazepam, etc.) up to 3 tables per day
Tardive dyskinesia (months and years from the start of taking medications)	Involuntary movements in certain muscle groups	Propranolol (anaprilin, obzidan) - in the absence of contraindications up to 30 mg per day Tremblex

Characteristics of new generation neuroleptics: new opportunities and limitations

Revolutionary in the treatment of schizophrenia and other mental disorders was the creation of a new class of so-called atypical neuroleptics. The first such drug was clozapine (Leponex, Azaleptin).

It has been noted that when it is prescribed, characteristic extrapyramidal effects do not develop or are observed only in the most sensitive patients to the drug or when medium and high doses of the drug are prescribed. In addition, unusual components of the effect of this drug were noted - normothymic (i.e., the ability to stabilize mood), as well as improvement in cognitive functions (restoration of concentration, consistency of thinking). Subsequently, new antipsychotics were introduced into psychiatric practice, which received the stable name atypical, such as risperidone (Rispolept, Speridan, Risset), olanzanpine (Zyprexa), quetiapine (Seroquel), amisulpride (Solian), ziprasidone (Zeldox), Abilify. Indeed, when treated with the listed drugs, extrapyramidal side effects develop significantly less frequently compared to treatment with classical antipsychotics and only when high or medium doses are prescribed. This feature determines their significant advantage over classical (“typical” or “conventional”) neuroleptics.

In the process of studying the effectiveness of atypical antipsychotics, other distinctive features. In particular, the effectiveness of clozapine (leponex, azaleptin) in the treatment of resistant, i.e. conditions resistant to the action of classical neuroleptics. Important property atypical antipsychotics are their ability to stabilize the emotional sphere, reducing mood swings in the direction of both downward (in depression) and pathological increase (in manic states). This effect is called normothymic. Its presence allows the use of atypical antipsychotics, such as clozapine (azaleptin), rispolept and Seroquel, as drugs that prevent the development of another acute attack schizophrenia or schizoaffective psychosis. IN lately The ability of new generation antipsychotics to provide positive influence on cognitive (cognitive) functions in people suffering from schizophrenia. These drugs help restore consistency of thinking, improve concentration, resulting in increased intellectual productivity. Such characteristics of the new generation of antipsychotics, such as the ability to normalize the emotional sphere, activate patients, and have a positive effect on cognitive functions, explain the widespread opinion about their effect not only on productive (delusions, hallucinations, catatonic symptoms etc.), but also to the so-called negative (decreased emotional response, activity, impaired thinking) symptoms of the disease.

Recognizing the noted benefits of atypical antipsychotics, it should be noted that they, like any other drugs, cause side effects. In cases where they have to be prescribed in high doses, and sometimes even in medium doses, extrapyramidal side effects still appear and the advantage of atypical antipsychotics over classical ones in this regard decreases. In addition, these drugs may have a range of other side effects that resemble those of classic antipsychotics. In particular, the administration of rispolept can lead to a significant increase in the level of prolactin (a pituitary hormone that regulates the function of the sex glands), which is associated with the appearance of symptoms such as amenorrhea (cessation of menstruation) and lactorrhea in women and engorgement mammary glands in men. This side effect was noted during therapy with risperidone (Rispolept), olanzapine (Zyprexa), and ziprasidone (Zeldox). In some cases, when prescribing such atypical antipsychotics as olanzapine (Zyprexa), clozapine (Azaleptin), risperidone (Rispolept), an individual side effect is possible in the form of weight gain, sometimes significant. The latter circumstance limits the use of the drug, since exceeding a certain critical body weight is associated with the risk of developing diabetes mellitus.

The prescription of clozapine (azaleptin) involves regular monitoring of the blood picture with a study of the number of leukocytes and platelets, since in 1% of cases it causes inhibition of blood growth (agranulocytosis). A blood test should be performed once a week in the first 3 months of taking the drug and once a month thereafter throughout the course of treatment. When using atypical antipsychotics, side effects such as swelling of the nasal mucosa, nosebleeds, low blood pressure, severe constipation, etc. are also possible.

Long-acting neuroleptics

Long-acting antipsychotic drugs are opening up new opportunities for helping people with schizophrenia. These are ampoule forms of antipsychotics for intramuscular injections. Injecting a neuroleptic into a muscle, dissolved in oil (for example, olive), allows one to achieve its long-term stable concentration in the blood. Being absorbed into the blood gradually, the drug exerts its effect within 2-4 weeks.

Currently, there is a fairly wide choice of long-acting antipsychotics. These are moditene-depot, haloperidol-decanoate, clopixol-depot (and clopixol prolong, but with a 3-day duration of action, clopixol-acufase), fluanxol-depot, rispolept-consta.

Conducting antipsychotic therapy with long-acting drugs is convenient because the patient does not have to constantly remember the need to take them. Only some patients are forced to take correctors for extrapyramidal side effects. There are undoubted advantages of such antipsychotics in the treatment of patients who, upon withdrawal medicines or a decrease in the concentration of the drug in the blood required for them, they quickly lose understanding of the severity of their condition and they refuse treatment. Such situations often lead to a sharp exacerbation of the disease and hospitalization.

Noting the potential of long-acting antipsychotics, one cannot help but mention increased risk development of extrapyramidal side effects when using them. This is due, firstly, to the large amplitude of fluctuations in the concentration of the drug in the blood during the period between injections compared to taking tablet antipsychotics, and secondly, to the inability to “cancel” the drug already introduced into the body with individual hypersensitivity to its side effects in a particular patient. In the latter case, you have to wait until the prolongation drug is gradually, over several weeks, removed from the body. It is important to keep in mind that of the long-acting antipsychotics listed above, only Rispolept-Consta is classified as atypical.

Rules for antipsychotic therapy

An important question about the antipsychotic treatment regimen is: how long, intermittently or continuously should they be used?

It should be emphasized once again that the need for therapy with antipsychotics in people suffering from schizophrenia or schizoaffective psychosis is determined by the biological characteristics of the brain. According to modern biological data scientific research schizophrenia, these features are determined by the structure and functioning of the dopamine system of the brain and its excessive activity. This creates a biological basis for distortions in the selection and processing of information and, as a result, for the increased vulnerability of such people to stressful events. Neuroleptics that normalize the functioning of the dopamine system of nerve cells in the brain, i.e. affecting the basic biological mechanism diseases, represent a means of pathogenetic treatment

The prescription of antipsychotics is, of course, indicated in the active period of a continuous disease (without remissions), and there are reasons to set the patient up for long-term treatment with these drugs, at least over the next few years. Neuroleptics are also indicated for exacerbation of the disease in case of its paroxysmal course. In the latter situation, you need to keep in mind that average duration The period of exacerbation for schizophrenia is 18 months. All this time, the readiness of symptoms that “went away” under the influence of treatment remains ready to resume when the antipsychotic is discontinued. This means that even if the symptoms of the disease have disappeared after a month from the start of therapy, it should not be stopped. Research shows that by the end of the first year after stopping antipsychotics, 85% of people with schizophrenia experience a return of symptoms, i.e. an exacerbation of the disease occurs and, as a rule, there is a need for hospitalization. Premature cessation of neuroleptic therapy, especially after the first attack, worsens the overall prognosis of the disease, because An almost inevitable exacerbation of symptoms excludes the patient from social activity for a long time, assigning him the role of “sick,” contributing to his maladjustment. When remission occurs (significant weakening or complete disappearance of the symptoms of the disease), the dose of antipsychotics is gradually reduced to the level necessary to maintain a stable condition.

Maintenance therapy is not always perceived by patients and their relatives as necessary. Often, stability of well-being forms erroneous opinion that the long-awaited well-being has arrived and the disease will not recur, so why continue treatment?

Despite the achieved well-being, a person suffering from schizophrenia or schizoaffective psychosis retains the peculiarity of brain functioning in the form of excessive activity of the dopamine neurotransmitter system, as well as increased vulnerability to stressors and readiness to develop painful symptoms. Therefore, taking maintenance doses of an antipsychotic should be considered as replenishing the deficiency of a certain substance in the body, without which it cannot function at a healthy level.

To help the person suffering from schizophrenia to rethink the intake of maintenance doses of antipsychotics and other necessary medications, the help of specialists is required, about which we'll talk in the next lecture. No less important, and sometimes paramount, is the understanding and support of his loved ones. Knowledge of the mechanisms of development of the disease and the essence of the assistance offered will help him gain greater confidence.

Neuroleptics (antipsychotic drugs, antipsychotics) are psychotropic drugs intended for the treatment of a variety of neurological, mental and psychological disorders. Also, in small quantities, drugs of this class are prescribed for.

Drugs in this group are a rather controversial method of treatment, as they entail many side effects, although in our time there are already so-called atypical neuroleptics of a new generation that are practically safe. Let's figure out what's going on here.

Modern antipsychotics have the following properties:

• sedative;
• relieve tension and muscle spasms;
• hypnotic;
• reduction of neuralgia;
• clarification of the thought process.

This therapeutic effect is due to the fact that they contain ingredients from Phenotaisine, Thioxanthene and Butyrophenone. It is these medicinal substances that have a similar effect on the human body.

Two generations - two results

Antipsychotics are potent drugs for the treatment of neuralgic, psychological disorders and psychosis (schizophrenia, delusions, hallucinations, etc.).

There are 2 generations of antipsychotics: the first was discovered in the 50s (and others) and it was used to treat schizophrenia, thought disorders and bipolar deviation. But, this group of drugs had many side effects.

The second, more advanced group was introduced in the 60s (it began to be used in psychiatry only 10 years later) and was used for the same purposes, but at the same time, brain activity did not suffer and every year the drugs belonging to this group were improved and improved.

About opening a group and starting to use it

As mentioned above, the first antipsychotic was developed back in the 50s, but it was discovered by accident, since Aminazine was originally invented for surgical anesthesia, but after seeing the effect it has on the human body, it was decided to change the scope of its application and in 1952, Aminazine was used for the first time in psychiatry as a potent sedative.

To the main merit this tool should include the abolition of lobotomy, since a similar effect from this procedure could be obtained medicinal method without surgical intervention.

A few years later, Aminazine was replaced by the more improved drug Alkaloid, but it did not stay long on the pharmaceutical market and already in the early 60s, second-generation antipsychotics began to appear, which had fewer side effects. This group should also include those that are still used today.

To date antipsychotic drugs It is also common to consider powerful medicinal tranquilizers, since they have a similar effect.

Pharmaceutical properties and mechanism of action of antipsychotics

Most antipsychotics have one antipsychological effect, but it is achieved in various ways, since each drug affects a specific part of the brain:

1. Mesolimbic mode reduces the transmission of nerve impulses when taking medications and relieves such bright severe symptoms like hallucinations and delusions.
2. Mesocortical method, aimed at reducing the transmission of brain impulses that lead to schizophrenia. Although this method is effective, it is used in exceptional cases, since affecting the brain in this way leads to disruption of its functioning. In addition, it should be taken into account that this process is irreversible and the abolition of antipsychotics will not affect the situation in any way.
3. Nigrostriate method blocks some receptors to prevent or stop and.
4. Tuberoinfundibular method leads to the activation of impulses through the limbic pathway, which, in turn, can unblock some receptors for the treatment of sexual dysfunction and pathological infertility caused by nerves.

Regarding pharmacological action, then most antipsychotics have an irritating effect on brain tissue. Also taking antipsychotics various groups negatively affects the skin and manifests itself externally, causing skin dermatitis in the patient.

When taking antipsychotics, the doctor and the patient expect significant relief, there is a decrease in the manifestations of mental or neuralgic disease, but at the same time, the patient is exposed to many side effects that should be taken into account.

The main active ingredients of the drugs of the group

Basic active ingredients, on which almost all antipsychotic drugs are based:

• Phenothiazine;
• Tizercin;
• Magentil;
• Nuleptil;
• Sonapax;
• Thioxanthene;
• Clopixol;
• Butyrophenone;
• Trisedyl;
• Leponex;
• Eglonil.

TOP 20 famous antipsychotics

Neuroleptics are represented by a very broad group of drugs; we have selected a list of twenty drugs that are mentioned most often (not to be confused with the best and most popular, they are discussed below!):

Other funds not included in the TOP 20

There are also additional antipsychotics that are not included in the main classification due to the fact that they are an addition to a particular drug. So, for example, Propazine is a drug intended to eliminate the mental depressing effect of Aminazine (a similar effect is achieved by eliminating the chlorine atom).

Well, taking Tizercin increases the anti-inflammatory effect of Aminazine. A similar medicinal tandem is suitable for treatment delusional disorders, received in a state of passion and in small doses, has a sedative and hypnotic effect.

It is important to know: the maximum permitted dosage of all these drugs (from the TOP-20) is 300 milligrams per day.

In addition, there are Russian-made antipsychotic drugs on the pharmaceutical market. Tizercin (aka Levomepromazine) has a mild sedative and vegetative effect. Designed to lock causeless fear, anxiety and neuralgic disorders.

The drug is not able to reduce the manifestation of delirium and psychosis.

Indications and contraindications for use

It is recommended to take antipsychotics for the following neurological and psychological disorders:

• schizophrenia;
• neuralgia;
• psychosis;
• bipolar disorder;
• depression;
• anxiety, panic, restlessness.

Contraindications:

• individual intolerance to drugs of this group;
• presence of glaucoma;
• defective liver and/or kidney function;
• pregnancy and active lactation period;
• chronic heart disease;
• coma;
• fever.

Side effects and overdose

Side effects of antipsychotics are as follows:

• represents an increase in muscle tone, but at the same time the patient experiences a slowdown in movements and other responses;
• disruption of the endocrine system;
• excessive sleepiness;
• changes in standard appetite and body weight (increase or decrease in these indicators).

In case of an overdose of neuroleptics, symptoms develop, blood pressure drops, drowsiness, lethargy sets in, and a coma with depression is possible. respiratory function. In this case, carry out symptomatic treatment with possible connection of the patient to mechanical ventilation.

Atypical antipsychotics

Typical neuroleptics include drugs quite wide range actions that can influence the structure of the brain responsible for the production of adrenaline and dopamine. Typical antipsychotics were first used in the 50s and had the following effects:

• removal of various origins;
• sedative;
• sleeping pills (in small doses).

Atypical antipsychotics appeared in the early 70s and were characterized by having far fewer side effects than typical antipsychotics.

Atypicals have the following effects:

• antipsychotic effect;
• positive effect on neuroses;
• improvement of cognitive functions;
• hypnotic;
• reduction of relapses;
• increased prolactin production;
• fight obesity and digestive disorders.

The most popular atypical neuroleptics of the new generation, which have virtually no side effects:

What is popular today?

TOP 10 most popular antipsychotics at this time:

Also, many are looking for antipsychotics that are available without prescriptions; they are few in number, but they still exist:

• Etaperazine;
• Paliperidone;

Doctor review

Today, it is impossible to imagine the treatment of mental disorders without antipsychotics, since they provide the necessary medicinal effect(calming, relaxing, etc.).

I would also like to note that you should not be afraid that similar drugs will have a negative impact on brain activity Since these times have passed, typical antipsychotics have been replaced by atypical ones of a new generation, which are easy to use and have no side effects.

Alina Ulakhly, neurologist, 30 years old

... a new group of drugs has appeared - antipsychotics, which cause extrapyramidal disorders to a lesser extent and generally have a more favorable profile of side symptoms.

AS DEFINITED BY MELTZER (1996) atypical antipsychotic - a drug that effectively eliminates both productive and negative symptoms and does not cause side neurological effects.

Because atypical antipsychotics cause fewer neurological side effects than classic antipsychotics*, they have become increasingly popular. In addition, the range of their use in disorders of the central nervous system has expanded. For example, risperidone is often used to treat patients with dementia**, the structure of which includes disorders such as anxiety and restlessness.

MECHANISM OF ACTION AND CLINICAL EFFECT atypical antipsychotics

Atypical antipsychotics are a group of drugs that are heterogeneous in terms of both neurotransmitter mechanisms of action, the range of main and additional psychotropic effects, and adverse events. Some of them are characterized by selective combined effects on serotonin/dopamine receptors, while others have a broader receptor profile or are specific dopamine receptor antagonists. It is believed that in the mechanism of action of atypical antipsychotics, their ability to block 5-HT2A serotonergic receptors plays an important role. But what is more important is not the absolute binding of 5-HT-2A receptors by neuroleptics, but the ratio of this indicator to the magnitude of binding of D2-dopaminergic receptors(as is known, traditional antipsychotics exhibit their activity due to their ability to block D2-dopaminergic receptors).

Blockade of 5-HT2A receptors is currently believed to provide the following clinical and pharmacological properties of new generation atypical antipsychotics:

(1) antipsychotic activity (it is assumed that 5-HT2A receptors at the level of cortical pyramidal neurons can play decisive role in the occurrence of psychoses due to their modulating effect on intracortical and cortico-subcortical glutamatergic neurotransmission);

(2) influence on negative symptoms (clinically significant role of blockade of 5-HT2A receptors in reducing primary negative symptoms caused by the interaction of the serotonergic and dopaminergic systems at the level of the prefrontal cortex; a decrease in the functional activity of this link of the serotonergic system reduces the inhibition of dopaminergic neurons caused by serotonin, which leads to the activation of dopaminergic transmission, in particular by increasing the release of dopamine from presynaptic terminals in the prefrontal cortex);

(3) impact on cognitive functions (it is assumed that this is due to an increase in the release of dopamine and acetylcholine in the structures of the prefrontal cortex; it is also assumed that under stress, blockade of 5-HT2A receptors prevents the negative impact of stress on cognitive processes in the hippocampus);

(4) reducing the risk of developing extrapyramidal disorders (it is believed that the interaction of serotonergic and dopaminergic neurons at the level of the striatum in normal conditions inhibits the activity of dopaminergic transmission, therefore blockade of 5-HT2A receptors reduces the serotonin-induced suppression of the activity of dopaminergic neurons and increases their functional activity, reducing the risk of extrapyramidal disorders).

All drugs in this group have pronounced adrenergic blocking and antihistamine properties, which determines the presence of sedative and hypotensive effects. Clozapine and olanzapine also block m-cholinergic receptors quite strongly, which is associated with corresponding side effects.

!!! THE KEY FEATURE OF ATYPICAL NEUROLEPTICS IS their ability to simultaneously block type 2 dopamine receptors (D2 receptors) and type 2A serotonin receptors (5-HT2A receptors), which determines the absence or mild severity of extrapyramidal side effects, as well as the lack of increased prolactin secretion when used.

Let's consider the classification of neuroleptics according to their neurochemical profile, and what place atypical neuroleptics occupy in it.

According to the neurochemical profile of action, all antipsychotics can be divided into 5 groups (S.N. Mosolov, clinical and neurochemical classification of modern antipsychotic drugs; Moscow Research Institute of Psychiatry, Ministry of Health of the Russian Federation):

First group make up selective (selective) blockers of D2 and D4 receptors (sulpiride, amisulpiride, haloperidol, pimozide). These drugs belong mainly to the group of benzamide and butyrophenone derivatives. In no large doses mainly due to the blockade of presynaptic D4 receptors, they activate dopaminergic transmission of nerve impulses and have a stimulating (disinhibitory) effect; in large doses, they block D2 receptors in all areas of the brain, which is clinically manifested by a pronounced antipsychotic effect, as well as extrapyramidal and endocrine ( due to prolactinemia) side effects.

To the second group include highly active D2 receptor blockers, as well as drugs that weakly or moderately block 5-HT2a and alpha1 receptors (flupentixol, fluphenazine, zuclopenthixol, perphenazine, etc.), i.e. mainly piperazine derivatives of phenothiazine or thioxanthenes close to them in stereochemical structure. Like the drugs of the first group, these antipsychotics primarily have a pronounced antipsychotic (incisive) effect, and also cause extrapyramidal side effects and prolactinemia. In small doses, drugs of this group have a moderate activating (psychostimulating) effect.

Third group make up polyvalent sedative neuroleptics that undifferentiatedly block most neuroreceptors . These drugs have a distinct blocking effect on dopamine receptors, and also provide strong adrenolytic and anticholinergic effects. This group includes most sedative neuroleptics, primarily aliphatic and piperidine derivatives of phenothiazine, as well as thioxanthenes close to them in stereochemical structure (chlorpromazine, levomepromazine, chlorprothixene, thioridazine, etc.). The spectrum of psychotropic activity of these drugs is dominated primarily by a pronounced primary sedative effect, which develops regardless of the dose used, and a moderate antipsychotic effect. In addition, drugs in this group, due to their pronounced anticholinergic effect, cause weak or moderately expressed extrapyramidal reactions and neuroendocrine side effects, but often lead to the development of orthostatic hypotension and other autonomic reactions due to pronounced blockade of alpha1-adrenergic receptors.

To the fourth group drugs include antipsychotics, balanced, i.e. V to the same degree, blocking D2 and 5-HT2a receptors (the latter to a slightly greater extent) and in moderate degree- alpha1-adrenergic receptors . To this group include representatives of the new generation of atypical antipsychotics (risperidone, ziprasidone and sertindole), having different chemical structure. The neurochemical mechanism of action of these drugs determines their selective effect primarily on the mesolimbic and mesocortical areas of the brain. Therefore, along with a clear antipsychotic effect, the absence or mild severity of extrapyramidal side effects (when using therapeutic doses), weak or moderate prolactinemia and moderate adrenolytic properties (hypotensive reactions), this group of antipsychotics, through indirect stimulation of dopaminergic transmission in the cerebral cortex, is able to correct negative symptoms.

Fifth group make up polyvalent atypical antipsychotics of tricyclic dibenzodiazepine or similar structure (clozapine, olanzapine, zotepine and quetiapine). Just like the drugs of the third group, they block most neuroreceptors in a non-differentiated manner. However, 5-HT2a receptors are blocked more strongly than D2 and D4 receptors, especially those located in the nigrostriatal region. This determines the actual absence or weak extrapyramidal effect and the absence of neuroendocrine side effects associated with increased prolactin production with a clear antipsychotic effect and the ability to reduce the severity negative symptoms. In addition, all drugs in this group have pronounced adrenolytic and antihistamine properties, which determines the presence of sedative and hypotensive effects. Clozapine and olanzapine also have a fairly pronounced blocking effect on muscarinic receptors and lead to the development of anticholinergic side effects.

Thus !!! ATYPICAL NEUROLEPTICS ARE DIVIDED INTO TWO GROUPS BY MECHANISM OF ACTION The first group of drugs (including clozapine, olanzapine and quetiapine) is characterized by interaction with several different neurotransmitter systems, in particular with dopamine, serotonin, noradrenergic, cholinergic and histamine receptors. The second group of drugs (consisting of risperidone, amperoside, sertindole and ziprasidone) exerts its effect primarily through its influence on only 2 types of receptors - dopamine and serotonergic. Moreover, the ability to block serotonergic receptors of these drugs exceeds the ability to bind to dopamine type D2 receptors.

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*Among the side effects of classical neuroleptics, the following are characteristic (neuroleptic syndrome): akathisia, parkinsonism and dyskinesia.

**However, as British researchers have established, it is precisely these patients who are at particularly high risk of developing a stroke while taking an antipsychotic. In general, in patients with dementia, the risk of cerebral stroke when using atypical antipsychotics increases almost 6 times (