SUMMARY

* The consequences of schizophrenia have a major impact in both social and economic terms. The reduction of suicide in the mentally ill is a main target within the `Health of the Nation' document.

* Many people with schizophrenia may not respond to `typical' antipsychotics. The `typicals' also tend to cause extrapyramidal side-effects (EPS). The `atypical' agents are claimed to have advantages over the `typicals' in these respects.

* Assessing the efficacy of antipsychotics is difficult as it relies upon subjective measures. Schizophrenia is a chronic illness, therefore, evidence from long-term usage is required to assess actual clinical effect. Generally, evidence regarding the safety and efficacy of `atypicals' is limited to short-term clinical trials. Only clozapine has been shown to be effective in treatment-refractory psychosis but its use is restricted by the fact that it can cause agranulocytosis.

* The `atypicals' appear to be at least as effective as haloperidol in treating positive symptoms. Evidence for their superiority in alleviating negative symptoms is weaker, especially for risperidone and sertindole. They all tend to cause fewer EPS than haloperidol, although the incidence increases with risperidone at doses above 8mg/day.

* Robust health economic data showing that the extra acquisition costs associated with the `atypical' drugs are compensated for by a reduction in other costs, such as those due to hospitalisation, are not available.

* GPs should only prescribe `atypical' antipsychotic medication following specialist psychiatric advice, ideally under shared-care agreements and/or according to local policy.