Antipsychotics

The discovery of the antipsychotic chlorpromazine made the British Medical Journal’s recent 15-item shortlist of the most important medical milestones since 1840. Serendipity has played an important role in the development of antipsychotic therapies, in combination with clinical observation and progressive pharmacological refinement. The progress from low-potency typical antipsychotics to high-potency agents, atypicals and beyond shaped the emergent discipline of psychopharmacology and prompted a fundamental change in our approach to patients with psychotic illnesses, from one of paternalistic guardianship to patient-led community-based care. Additional progress is still needed, as the current medication options are not yet ideal. Issues such as QTc prolongation, metabolic disturbances, suboptimal effectiveness and limited data supporting real-life prescribing algorithms are key areas to explore. This contribution reviews these issues in their historical context, pointing out current limitations and suggesting future therapy directions.