Antipsychotic medications typical

All psychotic symptoms do not respond in the same time frame when treated with antipsychotic medications. Typically, severe restlessness, agitation, and marked confusion may subside after a few hours or a few days of treatment. Howeveij longer periods of treatment are generally necessary to resolve symptoms such as delusions, hallucinations, and thought disorder. Some patients may show improvement in these symptoms within a week or two, but in some chronic schizophrenics, many weeks of treatment may be required to gradually reduce these positive symptoms. 

Typical and atypical antipsychotic medications (D2-receptor antagonists)... 

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]. 

What Is a Side Effect This chapter picks up where Chapters 1 and 2 left off. As we discussed in the earlier chapters, all medications, psychiatric and otherwise, have multiple effects. One takes a medication to achieve a therapeutic effect. Occasionally, a single medication may have more than one therapeutic effect. All other effects are side effects. Different medications may have differing therapeutic and side effects depending on the intended use. For example, trazodone and quetiapine are often prescribed to aid in sleep, and in this instance sedation is the desired effect, yet when used as an antidepressant and antipsychotic, respectively, the sedation is often an unwanted effect. Psychotropic medications typically have multiple effects. First, they usually interact with more than one nerve cell protein, be it a transporter or a receptor. Quite often, one of the medication s receptor or transporter interactions produces the therapeutic effect. The other interactions tend to not be involved in the therapeutic effect and only serve to produce side effects. Sometimes a neurotransmitter will have multiple different receptor types, but the medication interacts with... 

Hunter RH, Joy CB, Kennedy E, Gilbody SM, Song F. Risperidone versus typical antipsychotic medication for schizophrenia. Cochrane Database Syst Rev 2003. Issue 2. 

The psychosis that least resembles dreaming is that of schizophrenia, because, like mania, it has the paranoia and accusatory auditory hallucinations (which dreaming lacks), and the emotional tone is often flat (about as far away from dream elation as we can get). Anxiety is about the only shared property, and that is not very specific. Perhaps it should come as no surprise that the typical schizophrenic psychosis is so different from that of dreaming. After all, it is the neuromodulator dopamine that has been most strongly implicated in the pathogenesis of schizophrenia, and that is the only neuromodulator that has not been implicated in dreaming. We will discuss this interesting difference in more detail when we consider how antipsychotic medication may work. 

Khorram, B., Lang, D., Kopala, L., Vandorpe, R., Rui, Q., Goghari, V., Smith, G., Honer, W. (2006). Reduced thalamic volume in patients with chronic schizophrenia after switching from typical antipsychotic medication to olanzapine. American Journal of Psychiatry, 163, 2005-2007. 

With regards to the effects of antipsychotic medications on muscarinic and nAChR in the brain, only olanzapine resulted in a temporary increase of muscarinic binding sites in a long-term study of different typical and atypical antipsychotics (Terry et al., 2006). This result is in accordance with in vitro (Bymaster et al., 1996 Schotte et al., 1996) and in vivo (Raedler et al., 2000) studies showing that olanzapine has considerable affinity to mAChRs. 

The primary treatment for schizophrenia involves use of antipsychotic medications. These are classified as typical or first generation, and atypical. The atypical antipsycho tics differ from the typical in having relatively less extrapyramidal side effects, such as rigidity, dystonia (muscle spasm), akathi-sia (motor restlessness), and pseudo-Parkinsonian symptoms. 

Atypical Prescribed if the patient does not respond to typical antipsychotic medication... 

The relationship between ethnicity and neuroleptic malignant syndrome (NMS) is unknown. In case reports and epidemiological studies, the age and sex of patients with NMS have typically been noted, but ethnicity has not. A study in China found that 0.63% of patients in whom treatment with antipsychotic medication was begun developed NMS (Deng et al. 1990), and an Indian study found 0.2% of patients developing the disorder (Singh 1981). These rates are similar to those found in American and European studies. 

Patients with AD are more sensitive to antipsychotic side effects than other patient groups. Increased sensitivity to antipsychotic side effects in the elderly appears to be the result of altered pharmacodynamics rather than altered pharmacokinetics. Particularly problematic side effects are extrapyramidal side effects, postural hypotension caused by a-adrenergic blockade, and anticholinergic effects, including increased confusion, urinary retention, constipation, and dry mouth. For a more detailed description of antipsychotic side effects see Chap. 66 on schizophrenia. Overall, fewer side effects are seen with tlie newer atypical antipsychotics, making them a preferred choice for treatment of psychosis or aggression in the AD patient. Effective doses of antipsychotic medications are much lower than those typically used to treat schizophrenia (see Table 63-8). The rule of thumb is to start low and go slow. ... 

According to Carpenter, Conley, and Buchanan (1998), stimulants such as cocaine and amphetamines activate the dopaminergic system in the brain, which explains why the abuse of stimulants can induce a paranoid psychosis that mimics the positive symptoms representative of schizophrenia. In turn, if a person who is diagnosed with schizophrenia is given stimulants of this type, the psychosis may be exacerbated. It follows, therefore, that the typical antipsychotic medications act by blocking the dopamine receptors. 

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