Worldview of Psychiatry

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Treatment of ideopathic psychotic disorders including schizophrenia and mania was revolutionized by the serendipitous discovery of the phenothiazines (initially, chlorpromazine) and subsequent development of the thioxanthenes (e.g., thiothixene), butyrophenes (e.g., haloperidol), and their congeners in the 1950s. Virtually all of these drugs block dopamine D₂ receptors in direct correlation with their clinical potency as antipsychotic agents. However, these classic or “typical” neuroleptic agents regularly induce characteristic neurologic and endocrinologic side effects including dystonia, akathisia, bradykinesia, acute or late dyskinesias, and hyperprolactinemia.