Will atypical antipsychotics play a role in phase prophylaxis?

Over the last ten years, atypical antipsychotics have been increasingly used in the treatment of schizophrenia. Compared to typical neuroleptics, they promise a beneficial side effect profile (especially lack or low rates of extrapyramidal motoric symptoms) and are effective in the treatment of affective and cognitive symptoms. In the beginning, it was doubted whether this group of medication would be effective in the treatment of bipolar disorders. Randomized controlled trials have shown that atypical antipsychotics are highly effective in the treatment of acute mania, some studies have shown the same result also for relapse prophylaxis. However, such trials are not available for all substances within the group of atypical antipsychotics. It can be expected that the mechanism of action is valid for all atypicals. As opposed to typical neuroleptics, atypical antipsychotics can be used as phase prophylactic medication since they are effective in the acute phase and do not worsen one pole of the illness, an effect that has been shown for haloperidol which causes depressive symptoms. To answer the question of whether atypical antipsychotics will play a role in phase prophylaxis long-time data of individual atypicals are required, also to separately characterize their individual profiles. These profiles are important for establishing individual side effect profiles for extrapyramidal motoric symptoms, neuroendocrinological changes, and the metabolic syndrome.