Antipsychotics, also known as neuroleptics or major tranquilisers, are types of medications.
They are normally used to help people with some mental health problems — mainly schizophrenia and bipolar affective disorder. They can also be used to help people with severe anxiety or depression.
There are two main types of antipsychotics.
1. The older, typical or conventional antipsychotics, which include chlorpromazine, flupenthixol, haloperidol, levomepromazine, pericyazine, perphenazine, pimozide, prochlorperazine, promazine, sulpiride, trifluoperazine and zuclopenthixol.
2. The newer, atypical antipsychotics, which include amisulpride, aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, risperidone and ziprasidone.
Antipsychotics are sometimes used to treat some of the more challenging problems faced by some autistic people. Those problems include aggression, irritability, hyperactivity, self injury, and repetitive behaviour.
The National Institute of Health and Care Excellence (NICE, 2012 and 2013) suggests that antipsychotic medication can be used for managing challenging behaviour in autistic children, young people and adults. However it recommends that antipsychotics should only be used after psychosocial or other interventions have been shown to be insufficient or could not be delivered because of the severity of the behaviour. If antipsychotics are used, they should only be used under very strictly controlled conditions and under the supervision of a paediatrician or psychiatrist.
There is very strong research evidence to suggest that some atypical antipsychotics (such as aripiprazole and risperidone) may be beneficial for the treatment of aggression, irritability, hyperactivity, self injury, and repetitive behaviour in some autistic children and young people.
There is very little high quality research evidence on the effectiveness of most other antipsychotics as a treatment for anyone who is autistic.
There is evidence of significant side effects of some antipsychotics in some autistic children, young people and adults. Those side effects may include weight gain, hyperprolactinaemia (raised prolactin levels) and tachycardia (abnormally fast heart rate).
We agree with NICE that antipsychotics should only be used as part of a comprehensive treatment programme, under specialist supervision, where other measures prove insufficient.
Antipsychotics should be discontinued if there is no response after six weeks, and treatment should be suspended periodically to assess the individual’s condition.
When choosing antipsychotic medication, you should take into account side effects, the costs, the individual’s preference, and their response to any previous treatment with an antipsychotic.
Future research should compare different antipsychotics with each other to determine which is most effective for the treatment of which issues in which autistic individuals. It should also investigate the optimal dosage and length of treatment for different individuals, while also investigating the long-term effects of antipsychotics on individuals.
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