All antipsychotic drugs decrease dopamine neurotransmission. The conventional neuroleptic drugs block dopamine D2 receptors, leading to a gradual reduction of acute psychotic features and the prevention of relapse; they produce coarse neurological side effects at excessive doses. Clozapine was the first atypical antipsychotic in that it did not produce neurological side effects; it also produced greater therapeutic benefit than did the conventional neuroleptics. The newer atypical antipsychotic drugs add antagonism at type 2 serotonin receptors to D2 antagonism, and produce less neurological side effects; however, some of these drugs produce substantial weight gain, and elevations in lipids and insulin resistance. © 2009 Elsevier Ltd All rights reserved.
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