Modalités d'utilisation des neuroleptiques

Since their first use by Delay and Deniker in the 1950s, the principal indication of neuroleptics remains the treatment of psychosis in adults. These drugs have greatly improved the prognosis of schizophrenia. Their use has been extended to the treatment of bipolar disorders and psychotic symptoms associated with dementia. We emphasize second generation neuroleptic treatments, also called antipsychotic drugs, because of their preferential first-line use. Their efficacy in the treatment of positive symptoms of schizophrenia has been shown in many studies. However the improvement of primary negative symptoms and cognitive symptoms remains more controversial. Antipsychotic drugs induce less neurological side effects as compared with first generation neuroleptic treatments. The efficacy of the various second generation antipsychotic drugs is similar, but some side effects, such as weight gain or metabolic side effects (diabetes or dyslipidaemia) are very different when olanzapine and clozapine are compared with other antipsychotic agents. Antipsychotic drugs of the second generation have become first-line treatments in the treatment of first episode psychosis and that of schizophrenia. They are also preferentially utilized in the elderly and in subjects with neurological diseases.