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Psychoses Pharmacotherapy
- Management
- Many patients don't
see behavior as
strange
- May not understand
need for meds.
- May become agitated,
distrustful, and extremely
frustrated b/c they may not
comprehend why others can't
think like them.
- May become agitated,
distrustful, and extremely
frustrated b/c they may not
comprehend why others can't
think like them.
- May not understand
need for meds.
- Noncomplience may
result when side
effects are severe
- Especially high in
schizophrenics.
- Especially high in
schizophrenics.
- Primary goal is reducing
symptoms to allow social
relationships and ADLs
- Can be controlled, but
adverse effects are
common and
sometimes severe/
- Little difference in
efficacy among drugs.
- Newer ones have
lower incidence of
adverse effects.
- Newer ones have
lower incidence of
adverse effects.
- Drug selection is based
on clinician experience,
occurrence of adverse
effects, and pt. needs.
- 3 generations of
antipsychotics.
- Many patients don't
see behavior as
strange
- Conventional
Antipsychotics (first
gen)
- Also called neuroleptics
b/c of neurologic side
effects.
- Phenothiazines
- Positive signs of
schizophrenia.
- Block excitement
associated
w/symptoms.
- Difference in
potency & side
effect profiles.
- Hallucination &
delusions diminish
within days, but
other symptoms can
require 7-8 wks.
- Life-long treatment.
- Prevent dopamine &
serotonin from
occupying critical
neurologic receptor
sites.
- Anticholinergic effects are
common.
- Dry mouth, postural
hypotension, &
urinary retention.
- Ejaculation disorders & delay in
orgasm are common causes for
noncompliance
- Menstrual disorders also common
- High fever, tachycardia,
incontinence, confusion, and other
signs of NMS may occur.
- Each drug has slightly different side
effect spectrum
- Many of these have a broader spectrum
of action than just psychoses.
- Many have calming effects &
ease restlesness.
- Perminant extrapyramidal effects can result
- Dystonia, akathisia, secondary
parkinsonism, and tardive
dyskinesia
- Acute dystonias
occur early on.
- Severe muscle
spasms,
- Akathisia is most
common; pt. cannot
rest or relax.
- Symptoms of secondary
parkinsonism include tremor,
muscle rigidity, stooped
posture, and shuffling gait.
- Tardive dyskinesia occurs
w/long term therapy.
- Unusual tongue & face
movement, such as lip
smacking & wormlike
tongue motions.
- Unusual tongue & face
movement, such as lip
smacking & wormlike
tongue motions.
- Tardive dyskinesia occurs
w/long term therapy.
- Symptoms of secondary
parkinsonism include tremor,
muscle rigidity, stooped
posture, and shuffling gait.
- Severe muscle
spasms,
- Concurrent use of an anticholinergic may
be indicated when EPS cannot be
prevented.
- Benzotropine (Cogentin) may be
used for acute dystonia.
- Meds w/levodopa are usually avoided,
- Beta-blockers and benzos are
sometimes given for akathisia
- Beta-blockers and benzos are
sometimes given for akathisia
- Meds w/levodopa are usually avoided,
- Benzotropine (Cogentin) may be
used for acute dystonia.
- Acute dystonias
occur early on.
- Dystonia, akathisia, secondary
parkinsonism, and tardive
dyskinesia
- Many have calming effects &
ease restlesness.
- Many of these have a broader spectrum
of action than just psychoses.
- Each drug has slightly different side
effect spectrum
- High fever, tachycardia,
incontinence, confusion, and other
signs of NMS may occur.
- Menstrual disorders also common
- Dry mouth, postural
hypotension, &
urinary retention.
- Anticholinergic effects are
common.
- Prevent dopamine &
serotonin from
occupying critical
neurologic receptor
sites.
- Life-long treatment.
- Hallucination &
delusions diminish
within days, but
other symptoms can
require 7-8 wks.
- Block excitement
associated
w/symptoms.
- Positive signs of
schizophrenia.
- Non-phenothiazines
- Therapeutic effects & efficacy
equal to phenothiazines
- Same spectrum of adverse
effects as phenothiazines.
- Less sedation & fewer
anticholinergic effects.
- CNS depressants may have an
additive effect.
- They also block postsynaptic
D2 dopamine receptors.
- No significant advantage over
phenothiazines in treating
schizophrenia.
- No significant advantage over
phenothiazines in treating
schizophrenia.
- They also block postsynaptic
D2 dopamine receptors.
- CNS depressants may have an
additive effect.
- Less sedation & fewer
anticholinergic effects.
- Same spectrum of adverse
effects as phenothiazines.
- Therapeutic effects & efficacy
equal to phenothiazines
- Also called neuroleptics
b/c of neurologic side
effects.
- Atypical antipsychotics (second gen)
- Treats both positive and negative
symptoms.
- Exhibit therapeutic action w/o EPS
effects.
- Action likely unknown, but thought to
block dopamine D2, serotonin, and
alpha-adrenergic receptors.
- Loosely bound to D2
receptors, so fewer EPS
symptoms are caused.
- Adverse effects are fewer, but still
significant. Pt. must be monitored.
- Increased risk of weight gain, diabetes,
hypertriglyceridemia, and stroke.
- Increased risk for death if used to
treat dementia-related
psychoses.
- Some of these increase prolactin, which can
lead to menstrual disorders, decreased
libido, and osteoporosis in women.
- Decreased iibido,
impotence, and man
boobs in men.
- Decreased iibido,
impotence, and man
boobs in men.
- Some of these increase prolactin, which can
lead to menstrual disorders, decreased
libido, and osteoporosis in women.
- Increased risk for death if used to
treat dementia-related
psychoses.
- Increased risk of weight gain, diabetes,
hypertriglyceridemia, and stroke.
- Loosely bound to D2
receptors, so fewer EPS
symptoms are caused.
- Action likely unknown, but thought to
block dopamine D2, serotonin, and
alpha-adrenergic receptors.
- Exhibit therapeutic action w/o EPS
effects.
- Treats both positive and negative
symptoms.
- Dopamine-Serotonin System Stabilizers
(third gen).
- Also controls both positive and negative
symptoms.
- Well tolerated in schizophrenics.
- Associated w/lower incidence of EPS
than haloperidol, and fewer
weight-gain issues than other
atypicals.
- Anticholinergic effects are virtually non-existent.
- Ariprprazole (Abilify) is also used for
bipolar and mixed episodes of mania and
depression.
- Aripiprazole is used with brexpiprazole
for major depressive disorder
- Side effects include headache, nausea,
vomiting, fever, constipation, and anxiety.
- Side effects include headache, nausea,
vomiting, fever, constipation, and anxiety.
- Aripiprazole is used with brexpiprazole
for major depressive disorder
- Ariprprazole (Abilify) is also used for
bipolar and mixed episodes of mania and
depression.
- Anticholinergic effects are virtually non-existent.
- Associated w/lower incidence of EPS
than haloperidol, and fewer
weight-gain issues than other
atypicals.
- Well tolerated in schizophrenics.
- Also controls both positive and negative
symptoms.
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