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Antipsychotics

Oct 03, 20244 min read

Also termed as “Neuroleptics”, these drugs block dopamine receptors in the post-synaptic membrane and reduces dopaminergic activity. There are two general types: typical (first generation; “conventional”) and atypical (second generation) antipsychotics. There is also a new generation termed as Dopamine System Stabilizers.

  • For Schizophrenia, Bipolar Disorder, Autism, Psychosis, Tourette’s Syndrome, and Severe Aggression.

Typical Antipsychotics

Used to treat positive symptoms of psychosis, serving as a potent D2 blocker: delusions, hallucinations, disorganized thinking and behavior. Incidence of EPSs are high, also with high rates of Tardive Dyskinesia.

  1. Phenothiazines
    • Thorazine (Chlorpromazine)
    • Trilafon (Perphenazine)
    • Prolixin (Fluphenazine)
    • Mellaril (Thioridazine)
    • Serentil (Mesoridazine)
    • Stelazine (Trifluphenazine)
  2. Thioxantene
    • Navane (Thiothixine)
  3. Butyrophenones
    • Haldol (Haloperidol)
    • Inapsine (Droperidol)
  4. Dibenzazepine
    • Loxitane (Loxapine)
  5. Dihydroindolne
    • Moban (Molindone)

Atypical Antipsychotics

Treats both positive and negative symptoms of psychosis, being both a weak D2 receptor and a serotonin inhibitor: anhedonia, avolition, asociality, alogia, anergia, apathy, affective disturbances.

  • Clozaril (Clozapine)
  • Risperdal (Risperidone)
  • Seroquel (Quetiapine)
  • Zyprexa (Olanzapine)
  • Geodon (Ziprasidone)

Dopamine System Stabilizers

The latest generation of antipsychotic drugs that stabilize dopamine production, reducing the hyperdopaminergic activity associated with psychosis. It is also associated with reduced incidence of EPSs and TD.

  • Aripiprazole (Abilify)
  • Palliperidone (Invega)
TypicalAtypicalDopamine System Stabilizer
Conventional; Traditional (1950)New Generation (1994)Newest Generation (2002)
Treats (+) symptoms of psychosisTreats (+) and (-) symptoms of psychosisStabilizes dopamine output
Potent D2 receptor blockerWeak D2 receptor blockerWeak D2 receptor blocker
High incidence of EPS and TDLow incidence of EPS and TDRare incidence of EPS and TD

Side Effects

  1. Extrapyramidal Side Effects (EPSs):
    • Akinesia, Pseudoparkinsonism: motor retardation, reduced arm swinging, shuffling and festinating gait, mask-like face, salivation, tremors, bradycardia.
      • Treatment: Amantadine (Symmetryl) 100 mg b.i.d., an anticholinergic/dopamine agonist.
    • Akathisia: motor restlessness, pacing, tremors, rigid posture and gait.
      • Treatment:
        • Anticholinergics: Cogentin (Benztropin), Akineton (Biperiden), Kemadrin (Procyclidine), Artane (Trihexaphenidyl)
        • Beta Blockers: Inderal (Propanolol)
        • Benzodiazepine: Ativan (Lorazepam)
        • Changing prescribed antipsychotic drug
    • Dystonia: acute muscular rigidity and cramping with a stiff or thick tongue, torticollis, opisthotonos, oculogyric crisis. This may result in laryngospasms and respiratory distress. It is likely to occur within the first week of treatment for male clients younger than 40 years old who are receiving high potency antipsychotic medications.
      • Treatment:
        • Cogentin Mesylate (Benztropine) 1 to 2 mg IM, an anticholinergic
        • Benadryl (Diphenhydramine) 25 to 50 mg IM, an antihistamine
    • Tardive Dyskinesia: long-lasting, irreversible side effect of antipsychotics, involving eye-blinking, lip smacking, teeth grinding, tongue protrusion, cheek puffing, and body rocking behaviors. Prevention is applied by using the minimal therapeutic dosage possible, changing medications as necessary, and monitoring for signs of TD using the AIMS.
  2. Anticholinergic Side Effects: xerostomia (dry mouth), urinary retention, constipation, blurred vision.
    • Treatment and Management:
      • Xerostomia: offer sugarless candies or ice chips.
      • Urinary Retention: measure I&O, assess for bladder distention or sensation of bladder fullness.
      • Constipation: increase fluid intake, dietary fiber, and exercise.
      • Blurred Vision: provide a well-lit environment.
  3. Endocrine Side Effects: gynecomastia, sexual dysfunction, amenorrhea, risk for breast cancer.
    • Treatment and Management:
      • Gynecomastia: breast examinations; encourage discussion of effect on body image.
      • Sexual Dysfunction and Amenorrhea: report any changes of sexual desire and functioning.
  4. Cardiovascular Side Effects: tachycardia, arrhythmias, dysrhythmias.
    • Causes: Serentil (Mesoridazine), Inapsine (Droperidol), Mellaril (Thioridazine)
    • Management: assess radial and apical pulses, report feelings of lightheadedness and dizziness.
  5. CNS Side Effects: headache, dizziness, sedation, decreased alertness.
    • Treatment and Management: headaches may abate with accustomization to antipsychotics. Medication may also be taken at bedtime (as advised by the physician) to minimize effects. Caution the client when performing activities that require mental alertness.
  6. Dermatologic Side Effects: photosensitivity, dermatitis
    • Treatment and Management: avoid sunlight, utilize sunscreen, and supervise personal hygiene.
  7. Serious Side Effects
    • Agranulocytosis: fever, sore threat and mouth, body malaise. WBC count is <2,000 from halted production in the bone marrow.
      • Treatment and Management: notify physician, monitor WBC count, withhold further medication, and place the patient in reverse isolation.
    • Hepatotoxicity: fever, nausea, jaundice, abdominal pain, and an abnormal liver function test.
      • Treatment and Management: notify physician, monitor liver function test, withhold further medication, ensure adequate rest and diet.
    • Neuroleptic Malignant Syndrome: diaphoresis, change in mental alertness (from stupor to comatose), hyperthermia, labile blood pressure, agitation, tachycardia, tachypnea, muscle-rigidity (board-like arms and abdomen), pallor.
      • Treatment and Management:
        • Psychopharmacology: dopamine receptor antagonist e.g. Parlodel (Bromocriptin), beta blockers e.g. L-dopa (Levodopa), benzodiazepam e.g. Ativan (Lorazepam)
        • Notify physician, withhold further medication, admit client to ICU, administer IVF and anti-arrythmics, maintain body temperature.

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