Antipsychotics behavioral therapy

PCP intoxication is unpredictable, and talk-down therapy is not recommended. Sensory input should be minimized. Antianxiety and/or antipsychotic drug therapy may be necessary if behavior is uncontrollable. 

Indications include a wide variety of psychiatric disorders, in the first place schizophrenia, organic psychoses and other acute psychotic illnesses. However they are also of use for the manic phase of bipolar affective disorder and for psychotic depression. Under antipsychotic drug therapy patients become less agitated and restless, withdrawn and autistic patients may become more communicative, aggressive and impulsive behavior diminishes and hallucinations and disordered thinking disappear. 

Two decades ago, there was a growing awareness of the inappropriateness and harmfulness of prescribing neuroleptics to elderly patients ( Antipsychotic Drug Therapy, 1988 Gomez et al., 1990 Sherman, 1987). The use of neuroleptics for the behavioral control of the elderly produces toxicity even more readily than in younger patients, and it cannot substitute for needed human services. Sherman (1987) called into question the pharmaceutical company practice of placing advertisements for neuroleptics like Haldol and Navane in journals with a geriatric-practice orientation. 

PCP intoxication is more unpredictable and more difficult to treat than other psychosis-producing drugs. Most clinicians suggest that sensory input be minimized to the extent possible thus talk-down therapy is not recommended and may in fact make the patient worse. If PCP intoxication is suspected, patients should be left alone in a quiet, dimly lit room. If behavior is uncontrollable, antianxiety and/or antipsychotic drug therapy may be necessary. 

Botteron and Geller (1999) listed stimulants as first-line therapies for disruptive disorders in typically developing children, followed by antipsychotics, lithium, and carbamazepine. The psychostimulants have usually been shown to provide some improvement in disruptive behavior, although ADHD symptoms have ordinarily been the main target of treatment (Arnold,... 

Chlorpromazine (Thorazine) and thioridazine (Mellaril), both phenothiazine derivatives, are used for their antipsychotic effects in the control of severely disturbed or agitated behavior and in schizophrenia. Thioridazine has a higher incidence of antimuscarinic effects but a lower incidence of extrapyramidal symptoms. Pigmentary changes of the retina have been reported occasionally in association with chlorpromazine therapy, although it is recognized that only thioridazine produces retinal toxicity. 

Because antipsychotic therapy has shown only modest efficacy and poses a substantial risk of undesirable side effects, medications traditionally used to treat disruptive behaviors and aggression in other psychiatric and neurologic disorders have been suggested as potential alternatives. These alternatives include benzodiazepines, buspirone, carbamazepine, selegiline, and SSRls. 

Should antipsychotics fail to manage noncognitive behaviors, available evidence suggests that a trial of citalopram or carbamazepme may be appropriate second-bne alternatives. Only minimal evidence exists to support the use of valproate in this population. Lithium has shown no benefit and frequent toxicity. Clearly, more rigorous placebo-controUed studies are needed to determine the relative efficacy and place in therapy for these medication alternatives. 

Initial case reports of risperidone s improvement in aggressive behavior, hyperarousal, and flashbacks has led to further investigation into the adjunctive use of atypical antipsychotics in refractory PTSD. Quetiapine (mean dose 100 mg/day range, 25 to 300 mg/ day) reduced core PTSD symptoms over a 6-week period when added to current therapy. Olanzapine (mean dose 15 mg/day) added ad-junctively to SSRIs decreased PTSD symptoms and significantly improved sleep compared with placebo. Patients gained an average of 13.2 pounds over the course of the 8-week trial. ... 

Haloperidol is a phenylbutylpiperadine derivative antipsychotic, apparently cansed by dopamine-receptor blockage in CNS. It is indicated in the management of psychotic disorders control of Tonrette s disorder in children and adults management of severe behavioral problems in children short-term treatment of hyperactive children and long-term antipsychotic therapy (haloperidol decanoate). 

Psychopharmacological agents such as antidepressants, antipsychotics (in patients with personality disorders) and lithium (in patients with bipolar disorders) have been shown to be effective in preventing suicidal behavior. The efficacy of electroconvulsive therapy (ECT) is more controversial. Another equally important aspect of the optimal clinical management of suicidal patients is the quality of the doctor-patient relationship. 

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