SCHIZOPHRENIAPsychopharmacology

Psychopharmacology

The primary medical treatment for schizophrenia is

PSYCHOPHARMACOLOGY.

In the past:Electroconvulsive therapy Insulin Shock therapyPsychosurgery

Electroconvulsive Therapy

Insulin Shock Therapy

Psychosurgery

Antipsychotic medications ( Neuroleptics)

Chlorpromazine ( Thorazine ) , are prescribe primarily to for their efficacy in decreasing psychotic symptoms . They do not cure schizophrenia rather they are used to manage symptoms.

Conventional antipsychotic medications are DOPAMINE antagonist.

Conventional AntipsychoticsThese drugs are dopamine antagonists. They target positive signs of schizophrenia such as delusions,

hallucinations, disturbed thinking and other psychotic symptoms.Thioridazine Mellaril, Melleril, Novoridazine, Thioril

Mesoridazine Serentil

Levomepromazine Nosinan, Nozinan, Levoprome

Loxapine Loxapac, Loxitane

Molindone Moban

Perphenazine Trilafon

Thiothixene Navane

Trifluoperazine Stelazine

Haloperidol Haldol

Fluphenazine Prolixin

Droperidol Droleptan, Dridol, Inapsine, Xomolix, Innovar (+Fentanyl)

Zuclopenthixol Clopixol

Prochlorperazine Compazine, Stemzine, Buccastem, Stemetil, Phenotil

Atypical AntipsychoticsThese drugs are dopamine and serotonin antagonists,

they not only diminish positive symptoms but also lessen the negative signs of lack of volition and

motivation, and social withdrawal.Clozapine Clozaril

Iloperidone Fanapt

Lurasidone Latuda

Mosapramine Cremin

Olanzapine Zyprexa, Ozace

Paliperidone Invega

Perospirone Lullan

Quetiapine Seroquel

Remoxipride Roxiam

Risperidone Risperdal, Zepidone

Sertindole Serdolect

Sulpiride Sulpirid, Eglonyl

Ziprasidone Geodon, Zeldox

Maintenance Therapy are available in depot injection forms.

Two medications are available in depot injection forms for maintenance therapy:

Fluphenazine (PROLIXIN) in decanoateHaloperidol (HALDOL)in decanoate

The effects of medications are absorbed slowly over time in the client’s system, the depot injection is sesame oil.

The effects of these medications last for 2-4 weeks, eliminating the need for daily oral antipychotic medication.

The duration of action is 7-28 days for FLUPHENAZINE

4 weeks for HALOPERIDOL.

Serious neurologic side effects include :

Extrapyramidal side effectsAcute dystonic reactionsAkathisiaParkinsonism/ Pseudo parkinsonismTardive DyskinesiaSeizuresNeuroleptic Malignant Syndrome

SIDE EFFECTS:

Extrapyramidal Effects

EPS are reversible movement disorders induced by neuroleptic medication.

DYSTONIC reactions to antipsychotic medications appear early in the course of treatment and are characterize by spasms in discrete muscle groups such as the neck muscles (Torticollis) or eye muscles (oculogyric crisis).

These spasms also may be accompanied by protrusion of the tongue, dysphagia, laryngeal, pharyngeal spasms that can compromise the client’s airway, causing medical emergency.

Acute treatment consists of diphenhydramine (Benadryl) given either IM or IV, or Benzotropin (Cogentin) given IM.

Extrapyramidal Side effects:

PseudoparkinsonismPSEUDOPARKINSONISM or Neuroleptic-induced parkinsonism, includes shuffling gait, mask like Facies, muscle stiffness or cogwheeling rigidity and drooling.

Characterized by restless movement, pacing, inability to

remain still, and the client’s report of inner restlessness.

Clients are very uncomfortable with these sensations and may stop

taking the antipsychotic medication to avoid these side effects.

Treatment: Betablockers such as propanolol have been the

most effective in treating akathisia, whereas

Benzodiazepines have provided some success as well.

AKATHISIA

A late appearing side effect of antipsychotic medications, is characterized by abnormal,

involuntary movements such as lip smacking, tongue protrusion,

chewing, blinking, grimacing and choreiform movements of

the limbs and feet.These movements are

embarrassing for the clients and may cause them to become

more socially isolated, decreasing or discontinuing the

medication can arrest the progression.

Tardive Dyskinesia

Tardive Dyskinesia

Clozapine (Clozaril), an atypical

antipsychotic drug has not been found to cause this side effect, so it often recommended for clients who have

experienced tardive dyskinesia while

taking conventional antipsychotic drugs.

Screening clients for late appearing movement disorder – important!

ABNORMAL INVOLUNTARY MOVEMENT SCALE

* The client is observed for several positions and the severity of symptoms is rated from 0-4. * The AIMS can be administered every 3-6 months.

If the nurse detects an increase in score on the AIMS, indicating increased symptoms of tardive dyskinesia, he or she should notify the physician so that the client’s dosage of the drug can be changed to prevent advancement of tardive dyskinesia.

Seizures are an infrequent side effect associated with the antipsychotic drugs.

Seizures may be associated with higher doses of the medication.

Treatment is a lowered dosage or a different antipsychotic medications.

SEIZURE

Is a serious and frequently fatal condition seen in those being treated with antipsychotic medications.

Characterized by muscle rigidity, high fever, increased muscle enzymes(particularly creatine phosphokinase), and leukocytosis (increased leukocytes)

This can be treated by stopping antipsychotic medications. The clients ability to tolerate other antipsychotic medications after NMS varies but use of another antipsychotic appears possible in most instances.

Neuroleptic Malignant Syndrome

Clozapine has the potentially fatal side effect of agranulocytosis (failure of the bone marrow to produce adequate white blood cells).

Agranulocytosis suddenly develops characterized by fever, malaise ulcerative sore throat and leukopenia.

The drug must be discontinued immediately.

Must have weekly WBC counts.

Agranulocytosis

Agranulocytosis

• WBC must be assessed weekly for the first 6 months of clozapine therapy and every 2

weeks thereafter.• Clozapine is dispensed

every 7-14 days only and evidence of the WBC above 3000cells/mm3 is required before a refill is

furnished.

END