Rajdip BarmanUniversity of Iowa, USA
Title: Newer antipsychotics: Brexpiprazole, Cariprazine, and Lumateperone: A Pledge or Another Unkept Promise?
Antipsychotics have revolutionized the treatment of psychiatric disorders since clozapine was introduced in 1971. Antipsychotic medications are used for various indications such as schizophrenia, bipolar mood disorder, delusional disorders, acute psychosis, augmentation for antidepressants, delirium with agitation, etc. Among the psychotic disorders, schizophrenia is the most debilitating chronic disorder; however, the optimal treatment approach is under research. In a global burden of disease study involving more than 30000 respondents from four European countries, schizophrenia was found to have the highest functional burden across multiple physical and mental health issues.
Second-generation antipsychotics (SGAs) are most commonly used in treating schizophrenia spectrum disorders and bipolar mood disorder. Nevertheless, SGAs are well-known for their significant side effect profile, such as metabolic side effects, that is often a limiting factor for their long-term and short-term uses. Moreover, antipsychotic medications are often criticized for being less effective in treating disabling symptoms such as negative symptoms of schizophrenia resulting in poor quality of life and non-adherence. Therefore, newer antipsychotic agents are gaining attention for better efficacy and tolerability in treating psychiatric disorders. This review aims to appraise the scientific data on psychopharmacology, safety profile, and effectiveness of the newer additions to the list of SGAs, including brexpiprazole, cariprazine, and lumateperone.
We conducted a selective search utilizing PubMed, clinicaltrials.gov, and Cochrane databases to gather appropriate publications, keeping broad inclusion criteria. There were no restrictions on the age of the study population or the year of publication. We also cross-referenced articles and references to capture all existing studies. The review of the current literature depicts the possible efficacy in negative symptoms of schizophrenia and lesser metabolic side effects in short-term studies. However, long-term studies need to be conducted to compare these newer antipsychotics with other antipsychotic agents to ascertain if the newer medications are better than the others.
Dr. Rajdip Barman, MD is an attending psychiatrist, medical director & chair in the behavioral health department at Genesis Medical Center, Davenport, Iowa, United States. He is also an adjunct assistant professor at the Carver College of Medicine, University of Iowa.
He completed my medical school from Calcutta Medical College, Kolkata, India; psychiatry residency from Virginia-Tech Carilion School of Medicine, Roanoke, Virginia, US in the year 2016; and then completed Geriatric Psychiatry fellowship from Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, US in 2017. After completion of training in adult and geriatric psychiatry, he joined Berkeley Medical Center, West Virginia University Medicine as an assistant professor and served as clerkship director for the medical students as well. He has near 20 publications in reputed journals with near 150 citations. He has special interest and research experience on Late-onset PTSD and its correlation with cognitive decline, Trauma & stress-related disorders following patient suicide, inappropriate antibiotic use in older adults and currently researching on late-onset stress symptomatology. He has been serving as member of several executive committees in his institution, Board of Medicine, Iowa, APA and editorial board member of several journals as well.