Editing Psychosis (section)

=== Medication ===
The choice of which [[antipsychotic]] to use is based on benefits, risks, and costs.<ref name="Lancet09" /> It is debatable whether, as a class, [[typical antipsychotic|typical]] or [[atypical antipsychotic]]s are better.<ref>{{cite journal | vauthors = Kane JM, Correll CU | title = Pharmacologic treatment of schizophrenia | journal = Dialogues in Clinical Neuroscience | volume = 12 | issue = 3 | pages = 345–357 | year = 2010 | pmid = 20954430 | pmc = 3085113 | doi = 10.31887/DCNS.2010.12.3/jkane }}</ref><ref>{{cite journal | vauthors = Hartling L, Abou-Setta AM, Dursun S, Mousavi SS, Pasichnyk D, Newton AS | title = Antipsychotics in adults with schizophrenia: comparative effectiveness of first-generation versus second-generation medications: a systematic review and meta-analysis | journal = Annals of Internal Medicine | volume = 157 | issue = 7 | pages = 498–511 | date = October 2012 | pmid = 22893011 | doi = 10.7326/0003-4819-157-7-201210020-00525 | doi-access = free }}</ref> Tentative evidence supports that [[amisulpride]], [[olanzapine]], [[risperidone]] and [[clozapine]] may be more effective for positive symptoms but result in more side effects.<ref name="barry 2012" /> Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages.<ref name="AFP07">{{cite journal | vauthors = Schultz SH, North SW, Shields CG | title = Schizophrenia: a review | journal = American Family Physician | volume = 75 | issue = 12 | pages = 1821–1829 | date = June 2007 | pmid = 17619525 }}</ref> There is a good response in 40–50%, a partial response in 30–40%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people.<ref name="AFP10">{{cite journal | vauthors = Smith T, Weston C, Lieberman J | title = Schizophrenia (maintenance treatment) | journal = American Family Physician | volume = 82 | issue = 4 | pages = 338–339 | date = August 2010 | pmid = 20704164 }}</ref> Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia),<ref>{{cite journal | vauthors = Taylor DM, Duncan-McConnell D | title = Refractory schizophrenia and atypical antipsychotics | journal = Journal of Psychopharmacology | volume = 14 | issue = 4 | pages = 409–418 | year = 2000 | pmid = 11198061 | doi = 10.1177/026988110001400411 | s2cid = 27270415 }}</ref> but it has the potentially serious side effect of [[agranulocytosis]] (lowered [[white blood cell]] count) in less than 4% of people.<ref name="Lancet09" /><ref name="BMJ07">{{cite journal | vauthors = Picchioni MM, Murray RM | title = Schizophrenia | journal = BMJ | volume = 335 | issue = 7610 | pages = 91–95 | date = July 2007 | pmid = 17626963 | pmc = 1914490 | doi = 10.1136/bmj.39227.616447.BE }}</ref><ref>{{cite journal | vauthors = Essali A, Al-Haj Haasan N, Li C, Rathbone J | title = Clozapine versus typical neuroleptic medication for schizophrenia | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD000059 | date = January 2009 | volume = 2009 | pmid = 19160174 | pmc = 7065592 | doi = 10.1002/14651858.CD000059.pub2 }}</ref>

Most people on antipsychotics get side effects. People on typical antipsychotics tend to have a higher rate of [[extrapyramidal side effects]] while some atypicals are associated with considerable weight gain, diabetes and risk of [[metabolic syndrome]]; this is most pronounced with olanzapine, while risperidone and [[quetiapine]] are also associated with weight gain.<ref name="barry 2012">{{cite journal | vauthors = Barry SJ, Gaughan TM, Hunter R | title = Schizophrenia | journal = BMJ Clinical Evidence | volume = 2012 | date = June 2012 | pmid = 23870705 | pmc = 3385413 | url = http://www.clinicalevidence.bmj.com/x/systematic-review/1007/archive/06/2012.html | url-status = dead | archive-url = https://archive.today/20140911114812/http://www.clinicalevidence.bmj.com/x/systematic-review/1007/archive/06/2012.html | archive-date = 2014-09-11 }}</ref> Risperidone has a similar rate of extrapyramidal symptoms to haloperidol.<ref name="barry 2012" />