Psychosis and Antipsychotic Drugs

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Notes from Doctors in Training
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Psychosis and Antipsychotic Drugs
  1. Positive symptoms of schizophrenia
    1. Delusions
      1. Hallucinations (auditory)
        1. Disorganized speech
          1. Disorganized or catatonic behavior
          2. Negative symptoms of schizophrenia
            1. Flat affect
              1. Social withdrawal
                1. Lack of motivation and speech
                  1. Thought blocking
                    1. Poor grooming
                    2. Schizophrenia subtypes (DSM-IV)
                      1. Paranoid
                        1. Disorganized
                          1. Catatonic
                            1. Undifferentiated
                              1. Residual
                              2. Antipsychotics
                                1. Typical (traditional neuroleptics)
                                  1. Low potency
                                    1. Anticholinergic side effects
                                      1. Drugs
                                        1. Chlorpromazine
                                          1. Thioridazine
                                        2. High potency
                                          1. EPS
                                            1. Tardive dyskinesia
                                              1. NMS
                                                1. Drugs
                                                  1. Haloperidol
                                                    1. Fluphenazine
                                                      1. Loxapine
                                                        1. Thiothixene
                                                          1. Trifluoperazine
                                                      2. Atypical
                                                        1. Fewer EPS and anticholinergic side effects
                                                          1. Drugs
                                                            1. Olanzapine
                                                              1. Quetiapine
                                                                1. Risperidone
                                                                  1. Aripiprazole
                                                                    1. Clozapine
                                                                    2. Alpha-blocking side effects
                                                                      1. Sedation
                                                                        1. Hypotension
                                                                        2. Histamine-blocking side effects
                                                                          1. Weight gain
                                                                            1. Sedation
                                                                        3. Extrapyramidal side effects
                                                                          1. Within 1-5 days
                                                                            1. Acute dystonia
                                                                              1. Torticollis
                                                                              2. Within 1 month: bradykinesia
                                                                                1. Within 2 months: akathisia
                                                                                2. Neuroleptic malignant syndrome
                                                                                  1. Delirum and altered mental status
                                                                                    1. Autonomic instability
                                                                                      1. Muscle rigidity
                                                                                        1. Myoglobinuria
                                                                                          1. Hyperpyrexia
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