Response
Instructions:
Please read and respond to at least two of your peers’ initial postings. You may want to consider the following questions in your responses to your peers:
· Compare and contrast your initial posting with those of your peers.
· How are they similar or how are they different?
· What information can you add that would help support the responses of your peers?
· Ask your peers a question for clarification about their post.
· What most interests you about their responses?
Please be sure to validate your opinions and ideas with citations and references in APA format.
All peer responses are due by Sunday at 11:59 pm CT.
Estimated time to complete: 1 hour
Reply from April Williams
First-Generation vs. Second-Generation Antipsychotics
First-Generation Antipsychotics (FGAs)
Also recognized as typical antipsychotics, FGAs include Haloperidol, Chlorpromazine, Fluphenazine, Thioridazine, and Perphenazine. These medications primarily block dopamine D2 receptors, which improves reducing positive symptoms of psychosis such as delusions and hallucinations (Jaffe & Levine, 2021). However, this mechanism also influences extrapyramidal symptoms such as dystonia, parkinsonism, and tardive dyskinesia (Jaffe & Levine, 2021).
Second-Generation Antipsychotics (SGAs)
Also referred to as atypical antipsychotics, SGAs include Risperidone, Olanzapine, Quetiapine, Aripiprazole, and Lurasidone (Jaffe & Levine, 2021). . Second-generation antipsychotics aim for both dopamine and serotonin receptors, which expands their therapeutic profile (Jaffe & Levine, 2021). They are associated with lower risk of EPS and tardive dyskinesia and may offer improved control of negative symptoms and mood stabilization (Jaffe & Levine, 2021).
Effectiveness Comparison
Jaffe and Levine noted that SGAs had comparable efficacy in treating first-episode psychosis but fewer motor side effects, making them more suitable for maintenance therapy (2021). While SGAs are not completely more effective than FGAs, they are suitably accepted and preferred for long-term use due to their safety profile Jaffe & Levine, 2021).
Critical Analysis
Tardive dyskinesia and acute dystonia are both drug-persuaded but contrast in onset and reversibility (Stern et al., 2023). The author’s further detailed athetosis is typically non-drug-related and reflects structural brain damage. Tics are characterized as neuropsychiatric and frequently suppressible movement, differing from other movements (Stern et al., 2023). Comprehension of these characteristics is fundamental for differential diagnosis and applicable treatment planning, uniquely in psychiatric populaces subjected to dopamine-modulating agents.
References
Jaffe, A. B., & Levine, J. (2021).
Efficacy and effectiveness of first- and second-generation antipsychotics in schizophrenia. Journal of Clinical Psychiatry.
to an external site.
Stanford Medicine 25. (n.d.).
Involuntary movements and tremors. Stanford University School of Medicine.
to an external site.
Stern, T. A., Paudel, S., Vyas, C. M., Donovan, A. L., Van Alphen, M. U., & Petriceks, A. (2023).
Drug-induced abnormal involuntary movements: Prevalence and treatment. Primary Care Companion for CNS Disorders, 25(3), 22f03305.
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Reply from Erica OQuin
1. Which antipsychotics are considered first-generation and why are they used less often than second generation antipsychotics? Are second-generation antipsychotics more effective?
First-generation antipsychotics are defined as dopamine receptor antagonists. These particular antipsychotic drugs are also identified as typical antipsychotics. This group of drugs includes phenothiazines (trifluoperazine, perphenazine, prochlorperazine, acetophenazine, triflupromazine, mesoridazine), butyrophenones (haloperidol), thioxanthenes (thiothixene, chlorprothixene), dibenzoxazepines (loxapine), dihydroindoles (molindone), and diphenylbutylpiperidines (pimozide), Chokhawala and Stevens, (2023).
In contrast, Second-generation antipsychotics are serotonin-dopamine antagonists and are identified as atypical antipsychotics. According to this article, The Food and Drug Administration (FDA) has approved 12 atypical antipsychotics. These drugs are identified as risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone, asenapine, lurasidone, iloperidone, cariprazine, brexpiprazole, and clozapine, Chokhawala and Stevens, (2023).
PubMed collected real-world data to investigate the effectiveness and tolerability profiles of second-generation antipsychotics (SGAs). The study concluded that second-generation antipsychotics (SGAs) expressed higher effectiveness over first-generation antipsychotics (FGAs). Prolonged effectiveness and adherence to therapy were more prominent in SGAs than FGAs, Fabrazzo et al., (2022).
2. Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics.
Tardive dyskinesia (TD) is a weakening condition that is medication induced. This can be a potentially severe movement disorder characterized by involuntary, repetitive, purposeless movements that are present throughout the body. Tardive dyskinesia (TD) is irreversible and is a result of long-term exposure to antipsychotic medications as well as the dopamine receptor blocking agent (DRBA). This includes nonpsychiatric medications such as metoclopramide. Tardive dyskinesia can lead to psychological stress and decreased quality of life, Debrey and Goldsmith, (2021).
Dystonia is characterized by involuntary continuous contraction of agonist and antagonist muscles that results in abnormal posturing, twisting and repetitive movements/ tremulous, Pana and Saggu, (2023).
Athetosis involves is comprised of smooth movements that appear random and are not composed of identifiable small movements or movement fragments. In athetosis, happens in the same regions of the body are repeatedly. Athetosis may worsen with movement, but can also happen at rest, Lanska, (2013).
Tic disorders (TDs) are a group of neuropsychiatric disorders that can impact the physical, emotional, and social well-being of an individual. Tic disorders are more common in children than in adults and in males than in females. This can be contributed to several factors that include genetic, environmental, and immunological issues. In addition to tics, these patients may have sensory features, including premonitory urge; enhanced and persistent sensitivity to non-noxious external or internal stimuli; and behavioral manifestations, including attention deficit hyperactivity disorders, obsessive-compulsive disorders, and autism spectrum disorders, Desai, Kumar, and Goyal, (2023).
References:
Chokhawala K, Stevens L. Antipsychotic Medications. [Updated 2023 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
to an external site.
Debrey, S. M., & Goldsmith, D. R. (2021). Tardive Dyskinesia: Spotlight on Current Approaches to Treatment.
Focus (American Psychiatric Publishing),
19(1), 14–23.
to an external site.
Desai, I., Kumar, N., & Goyal, V. (2023). An Update on the Diagnosis and Management of Tic Disorders.
Annals of Indian Academy of Neurology,
26(6), 858–870.
Fabrazzo, M., Cipolla, S., Camerlengo, A., Perris, F., & Catapano, F. (2022). Second-Generation Antipsychotics’ Effectiveness and Tolerability: A Review of Real-World Studies in Patients with Schizophrenia and Related Disorders.
Journal of clinical medicine,
11(15), 4530.
to an external site.
Lanska D. J. (2013). Early Controversies over Athetosis: I. Clinical Features, Differentiation from other Movement Disorders, Associated Conditions, and Pathology.
Tremor and other hyperkinetic movements (New York, N.Y.),
3, tre-03-132-2918-1.
to an external site.
Pana A, Saggu BM. Dystonia. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
to an external site.
