When might a provider opt for first-generation antipsychotics (FGAs) instead of SGAs?

Choosing to use first-generation antipsychotics (FGAs) over second-generation antipsychotics (SGAs) is often influenced by the specific clinical circumstances of the patient. FGAs are particularly known for their efficacy in addressing acute symptoms of schizophrenia and other psychotic disorders. This is due to their potent dopamine D2 receptor antagonism which can lead to rapid reduction of psychotic symptoms.

In situations requiring immediate intervention, such as in hospitalized clients experiencing a severe acute psychotic episode, FGAs can provide quicker control of symptoms compared to SGAs. This rapid action is crucial in settings where stabilization of the patient is a priority, allowing for safety and further treatment planning.

While FGAs are also utilized in long-term treatment and can be considered for clients with a history of side effects from SGAs, the pressing need for immediate pharmacologic intervention in acute situations distinctly favors the choice of FGAs due to their historical use and the speed of onset of their effects.