Antipsychotic medications side effects

Basal ganglia Controls aspects of motor behavior Neuronal pathways connecting limbic system and prefrontal lobes Parkinson s disease, antipsychotic medication side effects (extrapyramidal symptoms (EPS)) Obsessive-compulsive disorder... 

What are the expected differences in side-effect profiles between ethnic groups, in particular with selective serotonic re-uptake inhibitors and atypical antipsychotics Can the morbidity of medication side effects be reduced, hence increasing treatment compliance and effectiveness ... 

Some medication side effects also occur only after prolonged administration and, as such, are products of the adaptive response to the continued administration of the medication. For example, taking a so-called conventional or typical antipsychotic for a long period of time can cause involuntary movements called tardive dyskinesias. These dyskinesias are believed to occur after chronic administration of the antipsychotic has caused changes in the density and/or sensitivity of dopamine receptors in brain regions that coordinate movement. 

Sometimes schizophrenics feel better not taking antipsychotic medications because they are able to entertain more grandiose notions about themselves and thereby lift their mood. Even more commonly, premature discontinuation occurs because patients are plagued by very unpleasant medication side effects. Like other people, they understandably don t like to suffer, and they respond by discontinuing. Appropriate education of patients regarding side effects and medical intervention (many side effects can be controlled with other medications) can improve the quality of life and greatly enhance compliance. It may be helpful to present medications as a tool for the person to use to help them control their illness, as a diabetic uses insulin. 

With the variety of antipsychotics currently available, using an alternative drug should be considered in patients who complain of poorly tolerated side effects. Because medication side effects are one of the primary predictors of patient nonadherence, the chnician should take advantage of the treatment options currently available in an... 

Take antipsychotic medications consistently, with or without supervision. Assist in arranging for followup of medication regimens. Monitor side-effect profiles that might decrease compliance. Educate client about importance of taking medications, side effects, and benefits. Ongoing Team, client... 

Psychotropic medication side effects, e.g. metabolic syndrome from antipsychotics. 

Research in psychopharmacology has shown that ethnicity must be considered in psychiatry as well (Lawson, 1986 Pi 8c Simpson, 2005). Early clinical trials with antipsychotic and antidepressant medications showed that ethnic minorities may respond when given the same doses as Caucasians, and may have more side effects (Lawson, 1986 Lawson, 1990). However, dosing cannot be used as a measure of appropriate pharmacotherapy because an extensive literature has shown that African Americans often receive higher doses of antipsychotics despite evidence of more side effects. 

Nevertheless, some atypical antipsychotic drugs, such as clozapine and olanzapine, have been linked to substantial weight gain, hyperlipidemia and type II diabetes, a new range of medically serious side-effects. 

Selection of an antipsychotic should be based on (1) the need to avoid certain side effects, (2) concurrent medical or psychiatric disorders, and (3) patient or family history of response. Fig. 71-1 is an algorithm for management of first episode psychosis. 

Quetiapine (Seroquel). Another atypical antipsychotic, quetiapine has also been approved by the FDA for the treatment of acute mania. It is usually administered twice daily at doses of 150-750mg/day. Like its counterparts, quetiapine is a well-tolerated medication. Its common side effects are drowsiness, dizziness, and headache. It causes less weight gain than olanzapine or clozapine but more than ziprasidone or aripiprazole. Quetiapine also does not cause agranulocytosis nor does it increase the risk of seizures. It can occasionally cause mild changes in liver function tests, but these usually return to normal even if the patient continues taking quetiapine. 

As a group, these medications have been known by several names. They have been called major tranquilizers. This is not altogether inaccurate these medications do calm or tranquilize. Physicians still use this name sometimes, especially when they re reluctant to use the word psychotic in a discussion with a new patient or his/her family. These medications have also been called neuroleptic, literally meaning seize the nerve cell, in the original Greek. This term is derived from the potential for the medications to cause extrapyramidal side effects. Finally, and most accurately we contend, these medications are called antipsychotics. 

These medications cannot be dosed solely based on their dopamine receptor blocking potency, because they also have effects on other receptors that must be factored into their dosing (see Table 4.6). For example, it is not unusual to begin treatment of a psychotic patient with a 5 mg dose of haloperidol. In terms of dopamine receptor blocking potency, 5 mg of haloperidol is more or less equivalent to 500 mg of chlorpromazine. If a patient were immediately treated with 500 mg of chlorpromazine, however, he/she would likely have side effect problems such as dizziness and excessive sedation. This is because the medications with the lowest dopamine receptor blocking potency are the most potent at other receptor systems responsible for these side effects. (See Table 4.7) The evolution of antipsychotics from low to medium to high potency has been driven not only by the desire to find... 

The net result is that low potency antipsychotics cause more histamine-blocking, acetylcholine-blocking, and a-1 adrenergic blocking side effects. The high potency antipsychotics are more likely to produce dopamine-blocking side effects. Now, let s take a brief look at each of the specific medications. 

Atypicai Antipsychotics. In the 1980s and early 1990s, the SSRIs began a revolution in the treatment of depression. Tried-and-true but side effect laden tricyclic antidepressants fell into disfavor as newer and safer medications became available. A similar revolution is taking place in the treatment of psychosis. A new generation of antipsychotics that have fewer of the more disturbing side effects and may well be more effective are now available. 

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