ANTIPSYCHOTICSKaty and Zoë

Psychosis

• Mental disorder with a broad range of symptoms.

• Patients ‘lose touch with reality’ and present with:

• hallucinations (seeing, hearing, smelling, tasting or feeling things that are not there)

• delusions (false and unshakable beliefs)

• Serious defects in judgement (reasoning, evaluating objectively)

• Disturbed cognitive processing (thinking)

Schizophrenia• ‘Positive’ symptoms of psychosis accompanied by

‘negative’ symptoms of mood.

Postitive-Psychosis symptoms (delusions, hallucinations, disorders of thinking etc.)

Negative The 4 ‘A’s-Affective blunting (loss of emotional responses)-Ahedonia (loss of ability to enjoy anything)-Alogia (‘poverty of speech’)-Apathy

Antipsychotics

Drug therapy works on the theory that psychosis is associated with increased dopamine release in the misolimbic pathway

First Generation (Classical)

• D2 receptor antagonists

• Also have action at M1, H1 and α1 receptors

• Low efficacy• 30% patients non-responders

• Examples:• Chlorpromazine• Haloperidol

Second Generation (Atypical)• Initially 5HT and dopamine antagonists

• Also have muscarinic, histamine and adrenergic receptor action.

• Better at dealing with negative symptoms than classical

• Reduced side effects

• Examples

• Clozapine

• Risperidone

• Olanzapine

• Quetiapine

Side Effects

• 5 main groups

• Extrapyramidal symptoms

• Cardiovascular (increased QT interval)

• Metabolic (weight gain, diabetes)

• Hormonal (hyperprolactinaemia)

• Other (sedation, headaches, anxiety)

Extrapyramidal symptoms

• Occurs in 75% of patients

• Result of altering the nigrostriatal pathway

• Dystonias (continuous spasms and muscle contractions) https://www.youtube.com/watch?v=McnIwCB2Q2c

• Parkinsonism (characteristic symptoms such as rigidity, bradykinesia and tremor)

• Akathisia (motor restlessness)

• Tardive Dyskinesia- involuntary choreiform movement (with prolonged use of classicals)http://www.youtube.com/watch?v=fLwZQBJs8fI

QUESTIONS?