Which atypical antipsychotic for schizophrenia?

Until the early 1990s, first-line drug therapy for patients with acute schizophrenia was usually a traditional antipsychotic, such as haloperidol. As recently as 1997, we recommended that newer, so-called 'atypical' antipsychotic drugs, such as olanzapine and risperidone, should be reserved for patients unable to tolerate traditional drugs. Now, atypical antipsychotics are widely regarded as better than traditional drugs, being generally less likely to cause troublesome extrapyramidal effects or hyperprolactinaemia. Current atypical antipsychotics differ from one another in important respects. Here we consider how important differences in their unwanted-effect profiles may influence the choice between these drugs for patients with schizophrenia.