such as haloperidol, fluphenazine, and chlorpromazine were used by 2.
19) Studies have mainly focused on atypical antipsychotics, and there is relatively little information on first-generation antipsychotics
Patients treated with second-generation antipsychotics are less likely to experience treatment-emergent extrapyramidal symptoms and tardive dyskinesia than patients treated with first-generation antipsychotics
The studies also support previous studies which indicated that low doses of first-generation antipsychotics
such as haloperidol are effective and well tolerated in patients with first-episode schizophrenia.
However, data suggesting a significantly greater risk for parkinsonism, akathisia, and tardive dyskinesia and a lack of evidence for lower weight gain compared to aripiprazole and ziprasidone do not seem to argue sufficiently for first-generation antipsychotic
use as a first-line strategy in youth.
What we actually found in our 2003 (1) and 2011 (2) meta-analyses was that "some antipsychotics are more efficacious than others," and the first-generation antipsychotic
vs second-generation antipsychotic distinction is not very useful clinically.
These results "do not support the widely held assumption that risperidone and olanzapine, two of the most widely used second-generation antipsychotics, are superior to an advantageous first-generation antipsychotic
for the treatment of early-onset schizophrenia and schizoaffective disorder," the authors concluded.
Gelenberg expressed concern that health systems will institute a "fail first model," whereby patients must fail on a first-generation antipsychotic
before they can be treated with one of the newer agents.
Many patients were prescribed more than one antipsychotic during the course of the year: 45% were given a first-generation antipsychotic
, 84% a second-generation agent, and 9% both combined.
The investigators chose to use perphenazine (Trilafon, 8-32 mg/day) as their first-generation antipsychotic
medication, representing the whole group of drugs, in part because haloperidol had already been compared unfavorably, and they did not want a drug that would be a "straw man" in the trial, Dr.
The study, the largest government-funded head-to-head-trial of atypical antipsychotics, found little difference in effectiveness between the atypicals olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon), and the conventional, first-generation antipsychotic
The use of a first-generation antipsychotic
(FGA) to lead in a second-generation antipsychotic (SGA) is a justifiable treatment strategy.