Antipsychotics medication selection

There is, however, a unique risk in the bipolar form that antidepressant treatment may trigger a switch into mania. This may occur either as the natural outcome of recovery from depression or as a pharmacological effect of the drug. Particular antidepressants (the selective serotonin reuptake inhibitors) seem less liable to induce the switch into mania than other antidepressants or electroconvulsive therapy. Treatment for mania consists initially of antipsychotic medication, for instance the widely used haloperidol, often combined with other less specific sedative medication such as the benzodiazepines (lorazepam intramuscularly or diazepam orally). The manic state will usually begin to subside within hours and this improvement develops further over the next 2 weeks. If the patient remains disturbed with manic symptoms, additional treatment with a mood stabilizer may help. 

The psychedelic movement was a spin-off of psychopharmacology, which, in the 1950s, was producing the selective antipsychotic medication that would, by the end of the twentieth century, contribute to the closing of the state mental hospitals. Some of the drugs produced by the pharmaceutical industry were inadvertently psychotogenic. 

Consequently, antipsychotic drugs all share a basic mechanism of action that involves dopamine receptor blockade. It is apparent, however, that they are not all equal in their ability to affect specific sub-types of dopamine receptors, and that their effectiveness and side effects are related to their affinity and preference for certain receptors. As indicated earlier, other neurotransmitters may also be involved in the pathogenesis of psychosis, and differences in specific antipsychotic medications may be related to their ability to directly or indirectly affect these other transmitters as well as block dopamine influence. Future studies will continue to clarify how current antipsychotics exert their beneficial effects and how new agents can be developed to be more selective in their effects on dopamine and other neurotransmitter pathways. 

The nurse is leading a medication group in a psychiatric unit. Which information should the nurse discuss with the clients concerning antipsychotic medications after discharge Select all that apply. 

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 ... 

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. 

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. 

After discussion with the patient and family about the risks and benefits of treatment, select the appropriate antipsychotic agent on the basis of the patient s physical status, the side-effect profile of the drug, and the patient s previous responses to medication, if known. 

Noncognitive symptoms are often the most difficult aspect of AD for the caregiver. Without effective treatment, nursing home placement is often needed. Selected antipsychotics and antidepressants have been useful for effective management of behavioral, psychotic, and depressive symptoms this helps to ease caregiver burden and allow the patient to spend additional time at home. Alternative treatments are also available in case initial choices are not successful. Improved tolerability with newer medications should also make treatment easier for these patients. 

Greater cantion regarding antipsychotic choice and use is necessary in the elderly, in patients with preexisting cardiac disease, and in patients taking dinretics or medications that may prolong the QTc interval. In patients older than 50 years of age, a pretreatment ECG is recommended, as are baseline sernm potassium and mag-nesinm levels. These factors shonld be considered in antipsychotic selection. ... 

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