THE CHOICE OF ANTIPSYCHOTICS: CONTEMPORARY KNOWLEDGE

Antipsychotics are a group of psychoactive drugs that eliminate delusions and hallucinations, improve the ability to test reality and lead to the reintegration of psychological functions and enable a return to reality. In addition to antipsychotic, they also have sedative, anxiolytic, antidepressant, antimanic stabilizing, anti-suicidal and antiemetic effects, therefore the drugs are used in the treatment of various other non-psychotic disorders. The objective of this paper is to point out the contemporary findings in the best choice of antipsychotics.We live in the period of psychopharmacology’s rapid progress and our possibilities in the treatment of psychotic disorders are increasing. In recent decades, treatment with antipsychotics has been significantly improved due to the development of new antipsychotics with better therapeutic effect and safer profile of side effects. The basic mechanism of action of antipsychotics is dopamine receptors, with an effect on the noradrenaline, serotonin, histamine, adrenergic, and cholinergic systems, and indirectly on the gamma-aminobutyric acid and glutamine system. All this makes the mechanism of action of antipsychotics extremely complex. There are several different subdivisions of antipsychotics, and in clinical practice the most common division is the so-called typical and atypical. Typical antipsychotics that achieve their mechanism of action by blocking the D2 receptor show effectiveness in the treatment of positive symptoms of schizophrenia, but have a much lower effect in the treatment of negative, affective and cognitive symptoms. They often have significant side effects. Atypical antipsychotics work on both positive and negative symptoms of psychosis. In severe forms of psychosis, they are often insufficient in the treatment of positive symptoms, so we are forced to use a combination of antipsychotics. Although antipsychotic monotherapy is the ideal therapy, in practice we are often forced to combine two or more antipsychotics, as well as combine antipsychotics with other groups of psychopharmaceuticals. It is not easy to answer whether combinations of antipsychotics are useful or not. The key to success is an individual approach, careful selection of the type and dose of antipsychotics, and the inclusion of psycho and socio-therapeutic methods that are indicated in each case individually. Keywords: antipsychotics, choice, contemporary knowledge.