As interesting as the above article is, I found what the editor of the British Journal of Psychiatry, Peter Tyrer said about the SGAs interesting, and the response to Tim Kendall's editorial from The Last Psychiatrist, illuminating.
From the Editor's desk
Spotlight on antipsychotics
The act of prescribing an antipsychotic drug in psychiatry is like sex; it is almost universal in 1,23Six papers in this issue touch on this subject from different angles. After looking at the similarities between the long-term benefits of clozapine and chlorpromazine in schizophrenia (Girgis et al, pp. 281–288), Kendall (pp.266–268) goes for the full frontal assault on the way guidance has been distorted by the pharmaceutical industry, ‘a story of fabricated classes, money and marketing’, with most changes being no more ‘than a cynical tactic to generate profit’. I have to declare my own interest here; I cannot see any justification for separating first- and second-generation antipsychotics and think these terms should be dropped far, far away from rediscovery by gullible psychiatrists.4 But Leucht & Davis (pp. 269–271) rightly emphasise the variability of antipsychotic drugs and that prescription should follow a ‘shared decision-making process’ with the patient, provided, some would add, that this is an honest and genuine one.5 Frighi et al (pp. 289–295) show that in those with intellectual disability, adverse effects are not usually major. My own explanation of this somewhat surprising finding is that because shared decision-making is much more difficult with this group than with those of normal IQ and that a minority of patients is unduly sensitive to these drugs, much lower doses are prescribed than in others and so there are fewer adverse consequences. Suzuki et al (pp. 275–280) confirm my own impressions from clinical practice that if there is no clinical response to an antipsychotic drug fairly soon after prescription (within 6 weeks) then its further prescription should be questioned, and long-term usage regarded as rare.
The Rise And Fall Of Atypical Antipsychotics [sic]