ANTIPSYCHOTIC. What do antipsychotics treat? Psychotic Disorders (Psychosis) Abnormal Thinking and...

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ANTIPSYCHOTIC ANTIPSYCHOTIC

What do antipsychotics treat?

Psychotic Disorders (Psychosis) Abnormal Thinking and Perceptions Loss of Contact with Reality Delusions (false beliefs) Hallucinations

ANTIPSYCHOTIC DRUGSANTIPSYCHOTIC DRUGS

CLINICAL USE1. Treatment of schizophrenia Reduce some of the positive symptoms

Hyperactivity Bizarre behavior Hallucinations and delusions

Facilitate functioning in both out andinpatient environments

ANTIPSYCHOTIC DRUGS ANTIPSYCHOTIC DRUGS

CLINICAL USE1. Treatment of schizophrenia Beneficial effects may take several

weeks to develop Individual patients may respond best

to specific drugs

CLINICAL USE1. Treatment of schizophrenia Negative symptoms

Older drugs do not have much effect Newer atypical drugs improve some

Emotional blunting Social withdrawal

CLINICAL USE2. Other psychiatric and neurologic

indications Psychotic symptoms of other psychotic

disorders Tourette’s syndrome and other tic

disorders

CLINICAL USE2. Other psychiatric and neurologic

indications Toxic psychoses caused by overdosage

of certain CNS stimulants Alzheimer’s and Parkinsonism

CLINICAL USE2. Nonpsychiatric indications Antiemetic action

Phenothiazines except thioridazine Antipruritics

Extra Pyramidal Symptoms

1. Reversible neurologic effects Occurs most frequently

Haloperidol Fluphenazine Trifluoperazine

Less frequent with clozapine Less common with the newer drugs

EPS (Extra Pyramidal Symptoms)

EPS include: Acute Dystonias: happens within hours Parkinsonism: develops gradually (Days –

Weeks) Tardive Dyskinesia: chronic development Tardive Dystonia: chronic development Akathisia

Parkinsonian Syndrome Parkinsonian Syndrome

Tremors Rigidity Cogwheeling Bradykinesia

May resemble Depression: Slowing in thinking Decreased initiative Masked face

Treatment of EPS

BRAND NAME GENERIC NAME

Akineton BiperidenArtane Trihexyphenidyl

Symmetrel Amantadine1

Akathisia

Restless Pacing

Akathisia

Akathisia: Inability to sit still

A feeling of restlessness, A need to keep moving,

Difficult to differentiate from illness-related behaviors

Akathisia

Appear Anxious: May misidentify akathisia as anxiety Anxiety can aggravate akathisia

Treatment: Lowering the dosage of the medication Anticholinergics: not always effective Propranolol: 10 to 80 mg/d Clonidine: 0.1 to 0.8 mg/d

Tardive Dyskinesia

2. Tardive dyskinesia Choreoathetoid movements of the

muscle of the lips and buccal cavity Maybe irreversible Tend to develop after years of therapy May appear as early as 6 months

2. Tardive dyskinesia Antimuscarinic drugs that improve

extrapyramidal effects increase theseverity of symptoms

No effective drug for treatment Switching to clozapine does not

exacerbate the condition

Neuroleptic Malignant SyndromeNMS

NMS(Neuroleptic Malignant Syndrome)

A rare but potentially fatal complication

Main clinical findings: Hyperthermia Severe muscular rigidity Autonomic instability:

Pulse/ BP/ Breathing/ Sweating Changing levels of consciousness Unstable vital signs

Lab tests: Creatine Phosphokinase (CPK)

Leukocytosis (increased WBC) Increased Myoglobin and Myoglobinuria

Mortality: 20 – 30 % May be higher when depot forms are

Treatments Stop the antipsychotics Supportive and symptomatic TX Medications:

Dantrolene

Bromocriptine

Amantadine

Metabolic Syndrome

Monitoring and Management

Equipment

3. Autonomic effects Result from blockade of peripheral

muscarinic receptors and alphaadrenoceptors

Strongest autonomic effects Thioridazine

Weakest Haloperidol

3. Autonomic effects Intermediate autonomic effects

Clozapine and most atypicalantipyschotics

Autonomic effects Atropine-like effects

Dry mouth Constipation Urinary retention Visual problems Not with ziprasidone and aripiprazole

3. Autonomic effects Alpha receptor blockade

Postural hypotension All atypical drugs

Failure to ejaculate Phenothiazines

4. Endocrine Dopamine D2 receptor blockade in

the pituitary Hyperprolactinemia Gynecomastia

6. Sedation More marked sedation

Chlorpromazine-Clozapine-Olanzapine-Thioridazine

Less sedating among the older drugs Fluphenazine and haloperidol

Least sedating among newer drugs Aripiprazole

7. Miscellaneous toxicities Visual impairment due to retinal

deposits Thioridazine

At high doses, fatal ventricular arrhythmias

Thioridazine

TOXICITY7. Miscellaneous toxicities Arrhythmias

Ziprasidone Agranulocytosis, seizure at high doses

Clozapine

TOXICITY8. Overdosage toxicity Usually fatal Hypotension

Fluid replacement Seizures

Diazepam or phenytoin Cardiotoxicity is difficult to treat

ANTIPSYCHOTIC. What do antipsychotics treat? Psychotic Disorders (Psychosis) Abnormal Thinking and...

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