Antipsychotic drugs summary

In summary, antipsychotic drugs have a significant impact on the acute resolution and the maintenance of remission of symptoms of schizophrenia, enabling focus on rehabilitation efforts directed at residual cognitive, social, and occupational disabilities. The... 

SUMMARY DRUG TABLE ANTIPSYCHOTIC DRUGS (Continued)... 

Geriatric Considerations - Summary Sink and colleagues systematic review showed statistically significant improvements on neuropsychiatric and behavioral scales for some drugs, but improvements were small and unlikely to be clinically important. Because of documented risks, and uncertain benefits, antipsychotic drugs should be used with caution in demented elderly persons, with frequent monitoring for side effects and a low threshold for discontinuing use. 

As noted above, OC failure may lead to accidental pregnancy and exposure of the developing fetus to potentially teratogenic properties of CBZ ( 383). Therefore, OC levels should be closely monitored and patients should notify their physician of spotting, an indicator of OC failure. Prothrombin time and the International Normalized Ratio (INR) should be monitored when patients are on warfarin and CBZ concomitantly. Patients stabilized on an antipsychotic may decompensate when CBZ is added. This may necessitate an increase in the antipsychotic dose and is one indication for TDM of antipsychotic drug levels ( 384). Conversely, when CBZ is discontinued, the dose of these other agents may need to be lowered to avoid toxicity. In summary ... 

In summary, consistent with the brain-disabling principles of biopsychiatric treatment presented in chapter 1, the neuroleptic or antipsychotic drugs produce a lobotomy-like deactivation syndrome characterized by emotional indifference or apathy, reduced spontaneity, and docility. This is the primary or therapeutic impact of all neuroleptic drugs including Haldol, Risperdal, Zyprexa, Geodon, and Seroquel. 

In summary, existing drug treatments for schizophrenia are of limited efficacy and have substantial side effects. New treatment can arise only on the basis of a new hypothesis. The phospholipid hypothesis of schizophrenia provides the theoretical basis for treatment with PUPA supplementation. Pre vlous studies using n-6 supplementation have had mixed results. We now have evidence from a double-blind, placebo-controlled trial that EPA, but not DHA, is effective in reducing the symptoms of schizophrenia. It is possible that the response to EPA is impaired by concomitant treatment with antipsychotic drugs that damage membrane phospholipids. The best treatment effects of EPA have been seen in patients who are otherwise unmedicated or who are currently taking clozapine. This remains to be explored further. 

Dufresne RL. Metabolic syndrome and antipsychotic therapy a summary of the findings. Drug Benefit Trends 2003 Suppl B 12-17. 

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