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BIOL 2P92 (117)


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Ingrid Makus

 Most imp develop in the treatment of s was the advent in the 1950s of several medications referred to as antipsychotic drugs. These drugs referred to as neuroleiptics ucxz they produce the side effects similar to the sump of a neurological disease st 1 generation (conventional) antipsychiotic drugs---one of most freq prescribed antipsychiotci drugs in the past 50 yrs was phenothiazine  use pf antihhsitimanines was produced to reduce surgical shock. Used to use for cold and asthma.  He notices that they made ppl sleepy and less fearful  new phenothiazine derivative which was called chlorpromazine . this drug proved very effective in calming ppl with s.  phenothiazines derive their therapeutic proprieties from the ability to block dopamine receptors in the brain and thus reducing the influence of dopamine on thought, emo and beh st  chlorpromazine (thorazine) was 1 used therapeutically in the US in 1954 and became preferred treatment for s. intro in north America by Canadian psychiatrist Heinz lehmann  by 1970 more than 85% of all ppl in state and provincial mental hospitals in the us and Canada were receiving this drug or another phenothiaizne  also used butyrophenones (haloperidol, haldol) and the thioxanthenes (thiothixene, navene) . these seem to reduce the positive symp of s but have much less effect on the negative symp  although antipsychitci drugs reduce some of the positive symp of s they are not a cure.  About 30-50% of ppl with s do not responded favourably to conventional antipsychitcs although some of these ppl may respond to newer drugs (clozapine)  Cuz of the side effects study found that about half the patients who take them quit after one year and up to three quarter quit after two years  Reported that about a third of ppl are noncompliant after only 4-6 weeks. A Canadian survey found that 56% reported that without seeking their doctors approval they had stopped taking their meds, the most common reason for non-compliance was drug side effects  Cuz of these high non compliance rates patients are freq treated with long lasting antipsychitcs (fluphenazine decanoate, prolixin) which are injected every 2- weeks  Other drugs used along with these to treat depression or anxiety or to stabilize mood  These meds include: lithium, antidepressants , anticonvulsants and tranquillizers  Antidepressant are also used with s patients who become depressed after a psychotic episode and as an add on treatment for ppl with s and pronounced negative symp  Ppl who respond positively to antiosyhcotics are kept on so called maintenance dosage of the drug just enough to continue the therapeutic effect  Ppl who are maintained on meds may make only marginal adjustment to the community  Although conventional antipsychotics keep positive symp from returning they have little effect on negative symp such as flat effect. Antipsychitcs have significant reduced long term institutionalization  Commonly reported side effects of antipsychotcis include dizziness, blurred vision, restlessness and sexual dysfunction  Group of disturbing side effects called extrapyramidal side effects stem from dysfunction of the nerve tracts that descend from the brain to the spinal motor neurons.  Extrapyramdial side effects resemble the symp of Parkinson’s disease. Ppl taking antipsychotics usually develop tremors of the fingers, a shuffling gait and drooling  Other side effects include dystonai a state of muscular rigidity and dyskinesia an abnormal motion of voluntary and involuntary muscles producing chewing movements as well as other movements of the lips, fingers and legs  Together these side effects cause arching of the back and a twisted posture of the neck and body.  Akasthesia is an inability to remain still- ppl pace constantly and fidget  In a muscular disturbance of older ppl with s called tardive dyskinesia the mouth muscles involuntarily make sucking, lip smacking and chin wagging motions. The whole body can be subject to involuntary motor movements. This syndrome effects about 10-20% of ppl treated with antipsyotics for a long period of time and is not responsive to any known treatme
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