Antipsychotic drugs symptoms

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... 

Behavioral changes may also occur with the use of the antipsychotic drugs. These changes include an increase in the intensity of the psychotic symptoms, lethargy, hyperactivity, paranoid reactions, agitation, and confusion. A... 

Extrapyramidal effects usually diminish with a reduction in the dosage of the antipsychotic drug. The primary health care provider may also prescribe an antiparkinsonism drug, such as benztropine (see Chap. 29) to reduce the incidence of Parkinson-like symptoms. 

When administering the antipsychotic drugs, the nurse observes the patient for extrapyramidal effects , which include muscular spasms of the face and neck, the inability to steep or s t still, tremors rigidity, or involuntary rhythmic movements The nurse notifiesthe primary health care provider of the occurrence of these symptoms because they may indicate a need for dosage adjustment. 

Determine whether the patient is taking an appropriate antipsychotic drug and dose and whether the patient has other symptoms that may need to be treated. 

It is common for lithium to be combined with other mood-stabilizing drugs or antipsychotic drugs, if necessary, in order to achieve more complete remission of symptoms. Studies indicate that monotherapy is often insufficient to reach this goal.17... 

Thirty-five to eighty-seven percent of the patients studied received antiparkinson drugs. Compared to other countries, Japan and Singapore used the most of these antidotes for drug-induced extrapyramidal symptoms. This is most likely related to the frequent use of high-dosage antipsychotic drugs and poly-antipsychotics (see Table 12.3). 

The positive symptoms are the most responsive to antipsychotic medications, such as chlorpromazine or halo-peridol. Initially, these drugs were thought to be specific for schizophrenia. However, psychosis is not unique to schizophrenia, and frequently occurs in bipolar disorder and in severe major depressive disorder in which paranoid delusions and auditory hallucinations are not uncommon (see Ch. 55). Furthermore, in spite of early hopes based on the efficacy of antipsychotic drugs in treating the positive symptoms, few patients are restored to their previous level of function with the typical antipsychotic medications [2]. 

The typical antipsychotic drugs, which for 50 years have been the mainstay of treatment of schizophrenia, as well as of psychosis that occurs secondary to bipolar disorder and major depressive disorder, affect primarily the positive symptoms[10]. The behavioral symptoms, such as agitation or profound withdrawal, that accompany psychosis, respond to the antipsychotic drugs within a period of hours to days after the initiation of treatment. The cognitive aspects of psychosis, such as the delusions and hallucinations, however, tend to resolve more slowly. In fact, for many patients the hallucinations and delusions may persist but lose their emotional salience and intrusiveness. The positive symptoms tend to wax and wane over time, are exacerbated by stress, and generally become less prominent as the patient becomes older. 

Positive symptoms (the ones most affected by antipsychotic drugs) include delusions, disorganized speech (association disturbance), hallucinations, behavior disturbance (disorganized or catatonic), and illusions. 

It is common for both the depressive and manic phases to occur simultaneously in what is termed a mixed state or dysphoric mania. During these mixed episodes, the patient s mood is characterized by symptoms of both a depression and mania. Mixed episodes often have a poorer outcome than classic euphoric mania and, as a rule, respond better to certain anticonvulsants and atypical antipsychotic drugs than to lithium. As many as 50% of admissions to inpatient psychiatric facilities for the treatment of manic episodes appear to be for mixed manic states. The recognition... 

Another serious side effect of clozapine is a risk of seizures. This mainly occurs at higher doses of the drug, and having a seizure is not necessarily a sufficient reason to stop clozapine permanently. If the clozapine has been especially helpful, an anticonvulsant can be added to protect against further seizures. Valproate (Depakote) may be best in this regard because it not only provides protection from seizures but also may help to relieve some of the symptoms of schizophrenia. Recently, it has become clear that two atypical antipsychotic drugs, clozapine and olanzapine, are associated with an increased risk for the development of type II diabetes. 

Lee PE, Gill SS, Freedman M, et al. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia systematic review. BrMed J 2004 doi 10.H36/bmj.38125.465579.55. 

Schizoid Personaiity Disorder (SPD). Again, there is very little research to guide in the selection of medications to treat the schizoid patient. If we conceptualize the symptoms of SPD as most resembling the negative symptoms of schizophrenia, the choice of agents would tend to favor the atypical antipsychotic drugs as opposed to the older typical antipsychotics. Consequently, we also recommend low doses of an atypical antipsychotic as a first-line treatment for SPD. 

Extrapyramidal symptoms may occur as a side-effect of antipsychotic drugs. 

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