The Rx Consultant 

Antipsychotics: A Focus on Indications, Monitoring, and Counseling

This CE activity was originally published in The Rx Consultant.  If you received credit for it previously, you cannot receive credit for it again.
Antipsychotic therapy improves the lives of millions with severe and persistent mental illnesses like schizophrenia and bipolar disorder. In recent years, FDA-approved use has expanded to other indications including depression and autism spectrum disorder. There has also been an explosion of off-label (unapproved) use as varied as behavioral problems and anxiety.

Antipsychotics are classified as either first-generation (FGA, "typical", or conventional) or second generation (SGA or "atypical"). The SGAs are among the top 5 therapeutic classes undergoing significant growth in medication spending. Aripiprazole (Abilify®) and quetiapine (Seroquel®) rank among the top 10 prescription drugs in terms of sales.

The use of the older FGAs has declined, while the use of SGAs increased nearly 6-fold from 1995 to 2008 among both adults and children. Factors contributing to this increase include expanded indications beyond schizophrenia and better tolerability of SGAs. Aggressive marketing of SGAs, including direct-to-consumer advertising and illegal promotion, also may have contributed to the increase in use. The number of physician office visits at which antipsychotics were prescribed off-label almost doubled between 1995 and 2008. Concerns have been raised about off-label uses that lack sufficient evidence for efficacy and safety. This issue summarizes the current evidence for FDA-approved antipsychotic indications (see Table 1.) as well as nonapproved uses - with a focus on comparative safety and tolerability among the agents. The supplement to this issue addresses the history of antipsychotic use, important antipsychotic interactions, and the SGA clozapine. Additional CE credit is available for the supplement.

Understanding the benefits and risks of antipsychotic use, especially in vulnerable patient populations such as children and elders, is critical for providing quality healthcare. Community practitioners can take an active role in working with patients and caregivers to ensure that antipsychotics are used for appropriate indications, and to provide them with recommended monitoring and education to improve safety.
This CE activity is a monograph (PDF file).



CE Hours


CE Units


Activity Type


Target Audience(s)

Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, and Registered Nurses


This CE activity was developed by The Rx Consultant, a publication of Continuing Education Network, Inc.

CE activities for Pharmacists and Pharmacy Technicians:
This continuing education (CE) activity meets the requirements of all state boards of pharmacy for approved continuing education hours.  CE credit is automatically reported to CPE Monitor.
CE activities for Nurse Practitioners and Clinical Nurse Specialists: 
    This continuing education activity meets the requirements of:
        The American Nurses Credentialing Center (ANCC) for formally approved continuing education (CE) hours, and CE hours of pharmacotherapeutics.
        The American Academy of Nurse Practitioners Certification Program (AANPCP) for acceptable, accredited CE.
    This is a pharmacotherapeutics/pharmacology CE activity.
  • The ANCC requires all advanced practice nursing certificants (CNSs and NPs) to complete 25 CE hours of pharmacotherapeutics as a portion of the required 75 continuing education hours.
  • Pharmacology CE is recommended by the AANPCP and will be required for Certificants renewing certification starting January 2017.  
  • Most State Boards of Nursing require a minimum number of pharmacy contact hours to renew an advanced practice license.
Accreditation Council for Pharmacy Education
Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Requirements for CE Credit

CE No Longer Valid
To receive CE credit, the participant must read the monograph in its entirety, complete the online post-test and receive a score of 70% or greater, and complete the online evaluation.
Pharmacists and Pharmacy Technicians -
Be sure your profile has been updated with your NAPB e-profile # and birth date information BEFORE completing the online evaluation, or your credits cannot be reported to CPE Monitor.
Continuing pharmacy education credit is automatically reported to CPE Monitor once the post-test & evaluation are successfully completed.




  • For commonly prescribed SGAs, state the FDA-approved indications and age ranges. Identify 2 off-label uses of antipsychotics for which there is at least limited evidence for efficacy.
  • Discuss extrapyramidal symptoms (EPS), metabolic effects, QT prolongation, and hyperprolactinemia associated with antipsychotics; list the agents most likely to cause them.
  • Provide recommendations to patients, families, and healthcare providers for managing antipsychotic adverse effects; include important monitoring parameters.
  • Discuss the relative effectiveness of the most commonly used SGAs in treating schizophrenia.


Julie Dopheide, Pharm.D.

Brief Bio : Julie A. Dopheide, PharmD, BCPP, FASHP is a Professor of Clinical Pharmacy, Psychiatry and the Behavioral Sciences at the University of Southern California School of Pharmacy and the Keck School of Medicine in Los Angeles, California
Disclosure : Dr Dopheide reports no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Pamela Mausner, MD

Brief Bio : Pamela Mausner, MD; Medical Writer/Editor and Healthcare Advocate; and Associate Editor, The Rx Consultant.
Disclosure : Dr.Mausner reports no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appear in this issue.

Tracy Farnen, PharmD

Brief Bio : Tracy Farnen, PharmD; Managing Editor, The Rx Consultant.
Disclosure : Dr. Farnen reports no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appear in this issue.

Activity Number


Release Date: Jun 18, 2013
Credit Expiration Date: Jun 18, 2016

CE Hours