Antipsychotic Medication -Handbook Of Clinical Psychopharmacology For Therapists

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Chlorpromazine

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The first antipsychotic drug used in 1952 as a postoperative sedative

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Antipsychotic medications act

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by producing a blockade of dopamine D2 postsynaptic receptor and their clinical potency correlate with the degree of DA blockage

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Neuroleptics (first-generation antipsychotics)

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cause certain neurological side effects

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First-generation antipsychotics (FGA)

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Are thiothixene, haloperidol, loxapine, molindone, and pimozide

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Second-generation antipsychotics (SGA)

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have weak dopamine blockers and cause minimal neurological side effects

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First-generations antipsychotics 5 groups of side effects

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Extrapyramidal, anticholinergic, antiadrenergic, tardive dyskinesia, and atypical side effects

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Extrapyramidal effects

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by dopamine blockage in the basal ganglia

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Three types of extrapyramidal symptoms

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parkinsonian side effects, dystonic symptoms and akathisia (intense feeling of restlessness)

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Anticholinergic effects

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Dry membranes, blurred vision, intestinal slowing, difficulty urinating, sedation, and sexual dysfunction

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Antiadrenergic effects

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Orthostatic hypotension (when the person stands up, blood pressure drops precipitously)

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Tardive dyskinesia effects

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Disorder involving involuntary movements that appear late in the course of the treatment

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Atypical side effects

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Allergic reactions, weight gain, agranulocytosis, hepatitis, hyperthermia, and neuroleptic malignant syndrome (NMS) characterized by fever, confusion and rigidity

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Second-generation antipsychotics (SGA)

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are strong serotonin (5-HAT2A and 5-HT2C) blockers and produce varying degrees of dopamine D2 blockage

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Most common SGA

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is Clozapine

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Clozapine

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has very low exprapyramidal side effects and very few cases of tardive dyskinesia.

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Clozapine side effects

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sedation is the most troublesome side effect and agranulocitosis (severe blood disorder) the most serious side effect

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Six other atypical agents of SGA

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Risperidone, paliperidone, olanzapine, quetiapine, aripiprazole, and ziprasidone

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Benefits of SGA

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better tolerability, reduced risk of tardive dyskinesia, reduction of negative symptoms, improved cognition, and reduced neuroanatomical changes

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Aripiprazole

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is less sedating and less prone to cause weight gain

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Olanzapine

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low extrapyramidal side effects. But its sedating and cause weight gain

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Paliperidone

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is a metabolite of risperidone and has the same side effects

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Quetiapine

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low extrapyramidal side effects. But is sedating and can cause dry mouth

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Ziprasidone

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has extrapyramidal side effects and it may have more effect on cardiac conduction than others

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Risperidone

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Extrapyramidal side effects and minimal sedation

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Recent concerns about SGA

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produce weight gain, alteration of carbohydrate metabolism similar to diabetes, and alteration of lipid metabolism