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The usefulness and use of second-generation - page 36 / 81





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Having reviewed the additional evidence and the comments and suggestions made during the national meetings, the Task Force re-examined the ideas and recommendations included in the Technical Review and agreed that no changes to these recommendations are necessary. The recommendations are therefore reprinted here, with only very minor changes, for ease of reference.

( 1)The currently available evidence indicates that the SGAMs have significant effects in reducing the positive symptoms of schizophrenia. They also appear to improve negative symptoms, affective symptoms and cognitive deficits, which are prominent in patients treated with conventional antipsychotic medications. Although evidence from controlled clinical trials is less firm for the latter types of symptoms than for positive symptoms, clinical experience, post-hoc analyses of controlled studies, and reports from uncontrolled studies support this view. In addition, the available evidence suggests potential advantages for the SGAMs,  both individually and as a class, for suicidal and aggressive behavior, and for relapse prevention and treatment adherence. The available evidence also strongly demonstrates that the SGAMs have lower side-effect risks in terms of EPSs, TD and, in most cases, the elevation of prolactin and its consequent endocrine effects. At the same time, clinical experience with some of the SGAMs demonstrates increased risks for weight gain and suggests possible risks for elevations in blood glucose, cholesterol and triglycerides. However, the extent of these risks and their potential medical consequences in terms of morbidity and mortality are not yet known.  As additional information about the side-effects of the SGAMs is developed, it is likely that new standards of care will be developed that include monitoring ofthe potential for medical morbidity.  Clinical experience and preliminary evidence indicate that the SGAMs are better received by patients, who are willing to take them more regularly and report that their quality of life  improved after they started treatment with the medications [239].

Thus, the evidence to date indicates that the SGAMs represent a useful addition to the array of treatment options for persons with psychotic states, primarily schizophrenia, and should be among the options of initial treatment.  More scientific evidence on their effectiveness would be welcome, but patients should have access to these medications now.  Furthermore, the use of SGAMs should be the first choice of treatment for certain groups of patients, including those with Parkinson’s disease, those with histories of EPS sensitivity, and perhaps those with tardive dyskinesia. A change from a FGAM to a SGAM  should be made for patients who experience mild akathisias with a therapeutic dose of a conventional drug, as well as for women with menstrual irregularities, due to elevated prolactin levels, on conventional antipsychotics. It also seems that these drugs are more likely to be tolerated by more drug-sensitive, younger and first-

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