Psychosis ziprasidone

Brook S, Lucey JV, Gunn KP. Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis. Ziprasidone I.M. Study Group. J Clin Psychiatry 2000 61(12) 933-41. 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Delusions/Psychosis. Demented patients who are acutely psychotic and agitated should be treated in much the same manner as demented patients with delirium. Low doses of a high potency conventional antipsychotic like haloperidol were once preferred. This was mainly because it can be given both orally and by injection. In recent years, the atypical antipsychotic ziprasidone, which is now also available in oral and injectable forms, has superseded haloperidol as the preferred agent when treating the acutely psychotic and agitated patient with dementia. As previously noted, ziprasidone affords the same tranquilizing benefit as haloperidol, it can now be administered via injection when necessary, and it avoids the problematic extrapyramidal symptoms of haloperidol to which patients with dementia are often keenly sensitive. 

Atypical antipsychotics cause fewer EPS than do conventional antipsychotics. Clozapine and quetiapine are the least likely to cause EPS and are therefore recommended for treatment of psychosis in patients with Parkinson s disease. With the notable exception of risperidone, atypical antipsychotics cause substantially less hyperprolactinemia than do conventional antipsychotics. Weight gain is a side effect of all atypical antipsychotics except ziprasidone and aripiprazole. Concerns about cardiac conduction delay with ziprasidone therapy exist and warrant consideration in patients who have... 

The magnitude of these properties is far from trivial and, in feet, makes the four atypical antipsychotics risperidone, olanzapine, quetiapine, and ziprasidone easily preferable as first-line therapies for psychosis, with conventional antipsychotics and clozapine as second-line therapies. 

Intramuscular ziprasidone has recently been compared with intramuscular haloperidol in the treatment of acute psychosis for a very short period (83). Patients were randomly allocated to intramuscular ziprasidone for up to 3... 

In an open 12-week study of ziprasidone in 12 patients with Parkinson s disease and psychosis, two withdrew because of adverse effects one had increased diurnal sedation on day 5 and the other had deterioration of gait at 1 week (7C). The other 10 patients reported significant improvement in psychiatric symptoms and no deterioration in motor symptoms. The small sample size and lack of a control group precluded definitive conclusions. 

A 38-year-old woman with a psychosis who took 4020 mg of ziprasidone had borderline intraventricular conduction delay (QRS duration 111 ms) the QTC interval was 445 ms (17). She oscillated between being drowsy and calm, and alert and agitated her blood pressure fell from 129/81 to 99/34 mmHg 4 hours later. She also had diarrhea and urinary retention. 

Gomez-Esteban JC, Zarranz JJ, Velasco F, Lezcano E, Lachen MC, Rouco I, Barcena J, Boyero S, Ciordia R, Allue I. Use of ziprasidone in parkinsonian patients with psychosis. Clin Neuropharmacol 2005 28 111 1. 

Intramuscular ziprasidone has recently been compared with intramuscular haloperidol in the treatment of acute psychosis for a very short period (66). Patients were randomly allocated to intramuscular ziprasidone for up to 3 days of flexible dosing (n = 90 last oral daily dose 91 mg) or haloperidol (n = 42 last oral daily dose 14 mg) followed by oral treatment to day 7. Mean reductions from baseline in all efficacy variables were significantly greater with ziprasidone than with haloperidol at the end of the study. The percentage of patients who had any adverse event was lower with ziprasidone (46%) than with haloperidol (60%) most of the adverse effects were mild or moderate. Four patients discontinued ziprasidone owing to adverse events compared with one in the haloperidol group. 

No placebo-controUed trials are currently available evaluating quetiapine, ziprasidone, or aripiprazole in psychosis of dementia. An open-label study suggests possible effect and good tolerability with quetiapine. For patients who respond inadequately, have elevated cardiovascular risk, or who have unacceptable side effects... 

Head-to-head comparisons have been carried out among atypical antipsychotic drugs [18 ]. Patients aged at least 18 years with symptoms of psychosis, of whom 44% were antipsychotic drug-naive, were randomized to risperidone ( =53), olanzapine ( =52), quetiapine ( =50), or ziprasidone ( =58), and followed for up to 2 years. On... 

Crespo-Facorro B, P4rez-Iglesias R, Mata 1, Ortiz-Garcia de la Foz V, Martinez-Garcia O, Valdizan EM, et al. Aripiprazole, ziprasidone, and quetiapine in the treatment of first-episode nonaffective psychosis results of a 6-week, randomized, flexible-dose, open-label comparison. J CHn Psychopharmacol 2013 33(2) 215-20. 

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