ANTIPSYCHOTIC

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ANTIPSYCHOTIC
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What do antipsychotics treat?

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

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ANTIPSYCHOTIC DRUGS

• CLINICAL USE
• Treatment of schizophrenia
• Reduce some of the positive symptoms
• Hyperactivity
• Bizarre behavior
• Hallucinations and delusions
• Facilitate functioning in both out and
• inpatient environments

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ANTIPSYCHOTIC DRUGS

• CLINICAL USE
• Treatment of schizophrenia
• Beneficial effects may take several
• weeks to develop
• Individual patients may respond best
• to specific drugs

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ANTIPSYCHOTIC DRUGS

• CLINICAL USE
• Treatment of schizophrenia
• Negative symptoms
• Older drugs do not have much effect
• Newer atypical drugs improve some
• Emotional blunting
• Social withdrawal

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ANTIPSYCHOTIC DRUGS

• CLINICAL USE
• Other psychiatric and neurologic
• indications
• Psychotic symptoms of other psychotic
• disorders
• Tourettes syndrome and other tic disorders

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ANTIPSYCHOTIC DRUGS

• CLINICAL USE
• Other psychiatric and neurologic
• indications
• Toxic psychoses caused by overdosage
• of certain CNS stimulants
• Alzheimers and Parkinsonism

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ANTIPSYCHOTIC DRUGS

• CLINICAL USE
• Nonpsychiatric indications
• Antiemetic action
• Phenothiazines except thioridazine
• Antipruritics

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Extra Pyramidal Symptoms

• EPS

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ANTIPSYCHOTIC DRUGS

• Reversible neurologic effects
• Occurs most frequently
• Haloperidol
• Fluphenazine
• Trifluoperazine
• Less frequent with clozapine
• Less common with the newer drugs

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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

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Parkinsonian Syndrome

• Parkinsonian Syndrome
• Tremors
• Rigidity
• Cogwheeling
• Bradykinesia
• May resemble Depression
• Slowing in thinking
• Decreased initiative
• Masked face

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Treatment of EPS

• BRAND NAME GENERIC NAME
• Akineton Biperiden
• Artane Trihexyphenidyl
• Symmetrel Amantadine 1

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Akathisia

• Restless Pacing

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Akathisia

• Akathisia Inability to sit still
• A feeling of restlessness,
• A need to keep moving,
• Difficult to differentiate from illness-related
  behaviors

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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
• BDZ

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Tardive Dyskinesia

• T D

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ANTIPSYCHOTIC DRUGS

• 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

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ANTIPSYCHOTIC DRUGS

• Tardive dyskinesia
• Antimuscarinic drugs that improve
• extrapyramidal effects increase the
• severity of symptoms
• No effective drug for treatment
• Switching to clozapine does not
• exacerbate the condition

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Neuroleptic Malignant Syndrome

• NMS

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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

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NMS(Neuroleptic Malignant Syndrome)

• Lab tests
• Creatine Phosphokinase (CPK)
• Leukocytosis (increased WBC)
• Increased Myoglobin and Myoglobinuria
• Mortality 20 30
• May be higher when depot forms are used

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NMS(Neuroleptic Malignant Syndrome)

• Treatments
• Stop the antipsychotics
• Supportive and symptomatic TX
• Medications
• Dantrolene
• Bromocriptine
• Amantadine

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Metabolic Syndrome

• Monitoring and Management

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Equipment
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ANTIPSYCHOTIC DRUGS

• Autonomic effects
• Result from blockade of peripheral
• muscarinic receptors and alpha
• adrenoceptors
• Strongest autonomic effects
• Thioridazine
• Weakest
• Haloperidol

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ANTIPSYCHOTIC DRUGS

• Autonomic effects
• Intermediate autonomic effects
• Clozapine and most atypical
• antipyschotics

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ANTIPSYCHOTIC DRUGS

• Autonomic effects
• Atropine-like effects
• Dry mouth
• Constipation
• Urinary retention
• Visual problems
• Not with ziprasidone and aripiprazole

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ANTIPSYCHOTIC DRUGS

• Autonomic effects
• Alpha receptor blockade
• Postural hypotension
• All atypical drugs
• Failure to ejaculate
• Phenothiazines

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ANTIPSYCHOTIC DRUGS

• Endocrine
• Dopamine D2 receptor blockade in
• the pituitary
• Hyperprolactinemia
• Gynecomastia

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ANTIPSYCHOTIC DRUGS

• Sedation
• More marked sedation
• Chlorpromazine-Clozapine-Olanzapine-Thioridazine
• Less sedating among the older drugs
• Fluphenazine and haloperidol
• Least sedating among newer drugs
• Aripiprazole

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ANTIPSYCHOTIC DRUGS

• Miscellaneous toxicities
• Visual impairment due to retinal
• deposits
• Thioridazine
• At high doses, fatal ventricular
• arrhythmias
• Thioridazine

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ANTIPSYCHOTIC DRUGS

• TOXICITY
• Miscellaneous toxicities
• Arrhythmias
• Ziprasidone
• Agranulocytosis, seizure at high doses
• Clozapine

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ANTIPSYCHOTIC DRUGS

• TOXICITY
• Overdosage toxicity
• Usually fatal
• Hypotension
• Fluid replacement
• Seizures
• Diazepam or phenytoin
• Cardiotoxicity is difficult to treat

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