Before initiating medications, a detailed history from the patients and a family member is taken. After that the patient is examined for any neurological signs, atypical symptoms of presentation or dysfunction in brain etc.  In addition, some blood investigations like complete hemogram, liver and kidney function tests, blood sugar, serum lipid profile, urine routine examination, and electrocardiogram may be done at baseline before initiating treatment.

It must also be understood that psychoeducation of the patient and family members is an important step which should be followed at each step, beginning from assessment to initiating the medications, and monitoring the progress. The patient and family members should understand that antipsychotics do not “cure” schizophrenia but treat the symptoms just the way insulin treats diabetes.

The antipsychotics are divided into two broad categories: the first-generation and the second generation. The first generation are relatively older molecules e.g. Haloperidol, Trifluoperazine, and these drugs act specifically on dopaminergic areas of brain. Thus due to their highly specific action on dopamine they are associated with higher chances of side effects such as rigidity, tremor, abnormal movements, Parkinson like symptoms etc.

The second-generation antipsychotics such as Aripiprazole, Olanzapine etc. have a relatively less specific action on Dopamine thus the chances of movement related side effects are less. In addition to dopaminergic areas, they also act on other brain areas like serotonin receptors, Glutamate receptors etc. But these drugs come with a higher risk of weight gain, obesity, change in lipid levels etc.

Overall, there is no evidence that second generation antipsychotics are clinically more effective than first generation, and the decision of which is to be preferred in a given individual is taken after discussing the side effect profile of a given drug.