Antipsychotics and Autism Ranking:

Key Features

Antipsychotics (also known as neuroleptics or major tranquillisers) are types of psychoactive medications used to treat a range of mental health problems including psychosis, anxiety and dementia.

Types

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 amisulpride, aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, risperidone and ziprasidone. 

Mechanism – how they work

Antipsychotics work by changing the amounts and the effects of different neurotransmitters (chemicals in the brain).  Traditional antipsychotics work mainly by reducing the amount and the action of dopamine. Atypical antipsychotics work mainly by changing the amount and the action of a range of neurotransmitters including dopamine, serotonin, noradrenaline and acetylcholine.

Format and Brands

Antipsychotics are available as tablets, capsules, liquids, intravenous injections and depot injections (long-acting).

The same antipsychotic may have several different brand names. For example, haloperidol is marketed as Dozic, Haldol and Serenace.

Dosage

According to Mind (2012)

“The British National Formulary (BNF – the main drug reference book for prescribers) gives maximum doses for some, but not all, of the antipsychotics. Generally, the drugs aren’t licensed for use above these dosages, but doctors can give you a higher dose, at their discretion. If you are in hospital, they may also prescribe medication to be given ‘as necessary’ (usually referred to as p.r.n.) which can mean in addition to your regular dose. As a result, your total dose could be above the BNF maximum. In this case, your psychiatrist has a duty to review your total dosage daily.”

For the latest information on specific formulations and recommended dosages please see our website entries on specific antipsychotics or refer to the BNF.

Usage

NICE (2013) has provided clinical guidance re the use of pharmacological interventions (such as antipsychotics) for behaviour that challenges in autistic children and young people.  The clinical guidance for the use of antipsychotics in autistic adults is very similar.

This guidance suggests that you consider antipsychotic medication for managing behaviour that challenges in children and young people with autism when psychosocial or other interventions are insufficient or could not be delivered because of the severity of the behaviour.

Antipsychotic medication should be initially prescribed and monitored by a paediatrician or psychiatrist who should identify the target behaviour, decide on an appropriate measure to monitor effectiveness, review the effectiveness and any side effects of the medication after 3–4 weeks and stop treatment if there is no indication of a clinically important response at 6 weeks.

If antipsychotic medication is prescribed, you should start with a low dose, use the minimum effective dose needed and regularly review the benefits of the antipsychotic medication and any adverse events.

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.

Updated

17 Jun 2022

Last Review

01 Nov 2016

Next Review

01 Mar 2023