Antipsychotics Flashcards
Psychotic Symptoms
Hallucinations
Delusions
Disorganized Speech
-Two or more present for at least one month
Symptoms
3 big categories
Positive
Negative
Cognitive
Positive Symptoms
Hallucinations
Delusions
Disorganized speech
Grandiose 大げさな
Negative Symptoms
Affective flattening
Anhedonia
Asociality
-Lacking the capacity for
social interaction
Avolition
-Lack of motivation or “drive”
Alogia
-Decreased speech fluency
Cognitive Symptoms
Poor concentration
Memory disturbances
Poor abstraction
Impaired decision making
Prodromal Phase
Withdrawn
Odd beliefs
Peculiar behavior
Acute Episode
Lose touch with reality
Hallucinations
Delusions
Flat or inappropriate affect
Difficulty with self-care
Treatment Goals
Prevent harm to self and others
Integrate back into the community
Medication adherence
Improve overall quality of life
Pathophysiology of Schizophrenia
Imbalance in dopamine
–Increased dopamine in certain areas of the brain leads to symptoms of psychosis
Antipsychotic MOA
a) 1st generation
b) 2nd generation
a) Dopamine blockade
“Typical”
b) Dopamine and Serotonin blockade
“Atypical”
Dopamine (D2) Receptor Blockade
a) Therapeutic
b) Adverse Events
1st generation
a) Improved positive symptoms of psychosis
b)Worsening of negative symptoms and cognition
Extrapyramidal movement disorders (EPS) and tardive dyskinesia (TD)
Dopamine and Serotonin Receptor Blockade
a) Therapeutic
b) Adverse Events
2nd generation
a)Reduced EPS and risk of TD
improvement in negative symptoms and cognition
b) Sedation
Weight gain
Treatment of Schizophrenia
First Generation (Typical)
Second Generation (Atypical)
Non-pharmacological treatment
Typical antipsychotics
1st generation
High Potency
–Haloperidol Hola___ idol
–Fluphenazine flu___azine
Most commonly use but most likely to cause EPS!!
–Chlorpromazine
–Thioridazine
–Perphenazine
–Loxapine
Extrapyramidal Symptoms (EPS)
Dystonia
Pseudoparkinsonism
Akathisia
Dystonia
Sustained muscle contractions
–Twisting, repetitive movements or abnormal postures
–Can look like a tremor or seizure
Painful and scary
Typically involve tongue, jaws, eyes, neck, limbs or toes
Usually occur 24-96 hours after a dose
Dystonia
Treatments
Diphenhydramine(Benadryl)
benztropine (Anti-Tremor)
benzodiazepines
Pseudoparkinsonism
Akinesia, bradykinesia, slowed speech
Signs
–Resting tremor
–Pill rolling tremor
–Cogwheel rigidity
–Gait/Posture changes
*Usually reversible within weeks of discontinuation
–Persists or worsens in 10-40%
Pseudoparkinsonism
Treatments
Benztropine(Anti-Tremor)
Trihexyphenidyl(antispasmodic)
Akathisia
Motor restlessness or inability to sit still （着座不能症）
Signs
–Pacing
–Shifting/shuffling
–Foot tapping
–“Inner restlessness”
*Occurs in 20-30% of patients on typical antipsychotics
Akathisia
Treatments
Beta-blockers
Benzodiazepines(depressants)
EPS Treatment Strategies
Decrease antipsychotic dose
Switch from high- to low-potency typical antipsychotic
Switch from typical to atypical antipsychotic
Use adjunctive medication
Tardive Dyskinesia (TD)
Involuntary abnormal movements generally occur after long-term antipsychotic therapy
–Face, tongue, lips, neck, trunk common
Early signs may be reversible!!
Symptoms are progressive.
Important to monitor and stop it early!!!
Tardive Dyskinesia
Treatment
Prevention
-most important prevention is intervention because early detection can be reversible
Early detection
*AIMS scale every 3-6 months
