With all the existing concerns about use of antipsychotic medications, particularly in off label situations, should we be also concerned about the potential for neurotoxicity? In this article we break down the topic and make suggestions for thoughtful patient care.

Weight gain is a common side effect of antipsychotic treatment in children and adolescents. Is one medication less problematic than another? This article reports on a comparison between risperidone and aripiprazole. The results might surprise you.

A randomized, double- blind, placebo-controlled trial studying the effects of olanzapine on change in body weight and obsessionality in adult outpatients with anorexia nervosa. Although strength of the study includes its large sample size, it is undetermined if patient weight gain is due to a therapeutic effect on anorexia or to olanzapine’s known metabolic effects.

With Vrylar’s new approval, there are now four atypicals antipsychotics with an indication in bipolar depression. Only two of these, however, are known to work in mania as well as depression. None of the atypicals stands out as the perfect choice for bipolar depression, but there are pros and cons to each that make them fitter better with certain patients.

Unlike the typical antipsychotics, atypicals improve both cognitive and psychotic symptoms of schizophrenia, so they must have procognitive effects of their own that can be harnessed in mood disorders, ADHD, and even dementia. The problem is that the data show the opposite.

There are reports of increased mortality from antipsychotics in older adults. Now, we have a paper showing increased mortality in children, adolescents, and young adults aged 5–24 years. Given the frequent use, both on- and off-label, of antipsychotics, does this change how we use them? And if so, how?

Akathisia is a sensation of inner restlessness so unpleasant that it independently elevates the risk of suicide. Among atypicals, quetiapine (Seroquel) has the lowest risk of akathisia, but that doesn’t mean it’s easy to take.

Clozapine is often used as a last resort in schizophrenia, even though practice guidelines recommend a trial of this medication after failing 2 antipsychotics. The current study set out to test a treatment algorithm based on those guidelines in patients with first-episode psychosis.

Once patients with schizophrenia are stabilized on an antipsychotic in the acute phase of their treatment, guidelines are unclear on how to continue dosing. Some guidelines recommend lowering the dose, others recommend maintaining the dose, and others give no firm recommendations whatsoever.