Weight gain is one of patients' chief concerns, Dr. Townsend said. "Many patients will simply refuse a drug that causes weight gain," he said.

In an analysis of 10 antipsychotic drugs for bipolar disorder published in the American Journal of Psychiatry, most drugs were associated with weight gain. Among the so-called conventional antipsychotics, Haldol (haloperidol) was associated with the least amount of weight gain from baseline (about 1 kg), while Mellaril (thioridazine) was associated with the most weight gain (more than 3 kg), Dr. Townsend said.

Among the second-generation antipsychotics, Risperdal (risperidone) was associated with the least amount of weight gain (about 2 kg) while Clozaril (cozapine) was associated with the most (about 4 kg), Dr. Townsend said.

Dr. Townsend also pointed out that the FDA has determined an increased risk of mortality based on a review of 17 placebo controlled studies of atypicals in older dementia patients with behavioral disorders. None of these agents is approved for use by the FDA in this condition.

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