Of antipsychotic agents

Nightengale BS, Crumly JM, Liao J, et al (1998). Economic outcomes of antipsychotic agents in a medicaid population traditional gents vs risperidone. PsyehopharmacBullltAy 373—82. 

The pharmacological action of antipsychotic agents is very complicated. Besides the ability to change behavior, these drugs also have a number of other central and peripheral... 

In this chapter, the primary focus is the dopaminergic actions of antipsychotic agents. When appropriate, brief reference is made to the neurochemistry of the dopaminergic system (covered in more detail in Chapters 1 and 5) and to other pharmacological agents manipulating dopaminergic parameters. 

The impact of antipsychotic agents on consciousness is immediately apparent from the frequency with which sedation and drowsiness are reported as side effects (Tune et ah, 1991), a property which historically has been used as a treat-... 

There are some clinically important pharmacodynamic drug-drug interactions to be mentioned. Antipsychotics will potentiate the central depressant effects of sedatives and of alcohol. They will also increase the risk of respiratory-depressant effects of opiates. Inducers of drug metabolic enzymes like for example rifampicin and several antiepileptics, may increase the elimination rate of antipsychotic agents and thus decrease their efficacy. 

Aggravation of the extrapyramidal effects of antipsychotic agents have been described and it has been reported that the use of lithium in combination with haloperidol may result in irreversible neurological toxicity. Lithium can increase the hypothyroid effects of antithyroid agents or iodides. 

Owens DG. Adverse effects of antipsychotic agents. Do newer agents offer advantages Dmgs 1996 51(6) 895-930. 

Acute angle closure and difficulty with accommodation can occur from the anticholinergic effects of antipsychotic agents. In addition, pigment deposits may develop in the cornea and lens. Pigmentary retinopathy has been reported with thioridazine. Keratopathy and corneal edema may occur occasionally during pharmacotherapy with chlorpromazine and fluphenazine... 

Tourette s syndrome (TS) is a chronic neurological disorder characterized by motor tics, involuntary verbalizations, and obsessive-compulsive behaviors. The current treatment lends itself to the use of antipsychotic agents. However, these treatments are only effective in about 70% of the treated population.84-85 Nicotine potentiates the behavioral effects of antipsychotics in a number of animal models.86 Clinical trials are under way involving patients receiving both nicotine and antipsychotic agents and appear to be promising.87 To date, there have been no studies mentioning the use of lobeline in TS. 

Gianfrancesco F, Grogg A, Mahmoud R, Wang R-H, Meletiche D. Differential effects of antipsychotic agents on the risk of development of type 2 diabetes mellitus in patients with mood disorders. Clin Ther 2003 25 1150-71. 

Barbui C, Ciuna A, Nose M, Patten SB, Stegagno M, Burti L, Amaddeo F, Tansella M (2004) Off-label and non-classical prescriptions of antipsychotic agents in ordinary in-patient practice. Acta Psychiatr Scand 109(4) 275-278. doi 283 [pii]... 

Sherman, D. (1987, January/February). Efficacy of antipsychotic agents for behavioral problems. The Consultant Pharmacist, pp. 9—12. 

Malmberg A, Jackson DM, Eriksson A, Mohell N (1993) Unique binding characteristics of antipsychotic agents interacting with human dopamine D2A, D2B, and D3 receptors. Mol Pharmacol 43 749-754. 

The threshold for seeking specialist involvement in starting antipsychotics is much lower than that when initiating antidepressant drugs. This reflects the complexity of diagnosis of psychotic illness, its chronicity, the increased likelihood of poor compliance without appropriate support and the potential toxicity of antipsychotic agents. 

Since the potency (therapeutic efficacy in relation to weight) of antipsychotic agents varies markedly between compounds, it is useful to think of the effective antipsychotic dose of classical agents in terms of chlorpromazine equivalents (see Table 19.5). For example, haloperidol has a relatively high anh-psychotic potency, such that 2-3 mg is equivalent to chlorpromazine 100 mg, whereas sulpiride 200 mg (low potency) is required for the same antipsychotic effect. 

Sexual Side Effects and Hyperprolactinemia. Clinical evaluation of the sexual function effects of antipsychotic agents are fraught with methodological difficulties including reduced sexual performance in unmedicated schizophrenics. The few well-con-trolled studies that have appeared have involved male subjects (74,75). 

During the search of antipsychotic agents without side effects (i.e. extrapyramidal side effects), 5-HT2 receptor... 

Detilippi JL, Crismon ML. The use of antipsychotic agents in patients with dementia. Pharmacotherapy 2000 20 23-33. 

Lithium should be used cautiously with antipsychotics because of alleged risks of neurotoxicity when hthium is combined with high doses of antipsychotic agents. 

BEHAVIORAL EFFECTS A number of effects in animal behavioral models have been used to predict the efficacy or potential adverse effects of antipsychotic agents. Despite their widespread use, these paradigms generally have not provided important insights into the basis for clinical antipsychotic effects. 

EXTRAPYRAMIDAL EFFECTS OF ANTIPSYCHOTICS The acute adverse clinical effects of antipsychotic agents are best mimicked in animals by assessing catalepsy in rats (immobility that allows an animal to be placed in abnormal postures that persist) or dystonia in monkeys. Late dyskinetic effects of antipsychotics are represented by the development of vacuous chewing... 

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