Lecture Notes: Antipsychotic Medications

Overview

• Upcoming topics: Schizophrenia and psychotic disorders
• Focus: Antipsychotic medications
• Types of Antipsychotic Medications:
  • Conventional (First generation/typical)
  • Atypical (Second generation)

Conventional Antipsychotics

• Examples: Chlorpromazine, Haloperidol
• Used for:
  • Schizophrenia
  • Bipolar disorder
  • Some personality disorders (e.g., Schizotypal)
• Mechanism: Affect dopamine, primarily addressing positive symptoms (hallucinations, delusions)
• Side Effects:
  • Extrapyramidal Symptoms (EPS):
    • Movement disorders due to dopamine effects
    • Akathisia (restlessness)
    • Akinesia (lack of movement)
    • Drug-induced Parkinsonism
    • Dystonia (muscle spasms)
    • Tardive dyskinesia (irreversible mouth movements)
  • Other: Agranulocytosis, anticholinergic symptoms
  • Neuroleptic Malignant Syndrome:
    • High fever, rigidity, altered mental status; medical emergency
• Patient Education:
  • Importance of informed consent
  • Awareness of side effects

Atypical Antipsychotics

• Examples: Abilify, Clozapine, Risperidone, Geodon
• Used for:
  • Schizophrenia
  • Bipolar disorder
  • Some personality disorders
• Mechanism:
  • Affect both dopamine and serotonin
  • Address positive symptoms and some negative symptoms (e.g., social withdrawal)
• Side Effects:
  • Metabolic syndrome (weight gain, diabetes, hypertension)
  • Lesser chance of EPS compared to first generation
  • Agranulocytosis risk, especially with Clozapine (black box warning)
• Patient Education:
  • Educate on potential side effects
  • Monitoring for metabolic symptoms and CBC for agranulocytosis

Specific Concerns

• Agranulocytosis:
  • Low white blood cell count, leading to infection risk
  • Especially concerning with Clozapine
  • Requires frequent lab monitoring and special dispensing protocols
  • Awareness of mild symptoms (e.g., sore throat, headache) can indicate serious issues, beware of fever

Other Reactions and Considerations

• Anticholinergic Reactions:
  • Dry mouth, constipation, blurred vision, urinary retention
• Hypertensive Crisis:
  • Severe headache, high BP, palpitations
• CNS Depression:
  • Sedation, confusion, agitation, hallucinations

Conclusion

• Importance of monitoring and educating patients
• Reach out for questions or further clarification