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Dalhousie University
NURS 2050
Cynthia Barkhouse Mckeen

Antipsychotics • also used to treat other conditions • Official indications: schizophrenia, schitzoaffective disorder, bipolar disorder, depression, • Other uses: tics, behaviour problems, obsessive compulsive disorder Symptom Dimensions Of Schizophrenia: Positive Symptoms Negative Symptoms Cognitive Symptoms Affective Symptoms Hallucinations Alogia: little speech Impaired attention Depression meds are good at getting rid/dulling this) Delusions- false beliefsAnhedonia: lack of Impaired memory & Loss of interest a dream in reality pleasure Bizarre Behaviour: Withdrawal: no Executive functioning anxiety Hostility interest (being about to adapt to a new plan) Antipsychotics Antipsychotics Antipsychotics Antipsychotics effectiveness +++ effectiveness +- effectiveness +- effectiveness +- Positive Symptoms: things are added (voices, seeing things ect.) Negative Symptoms: things are taken away (motivation, follow through, interactions, etc.) **Are better treated with social support/rehab than pills for neg. Symptoms Affective Symptoms: mood instability EPS Dopamine Pathways: (all block dopamine receptors- D2 receptors, block it but not all the time. If you block it for too long you will get side effects. i.e. motor symptoms) 1. Nigrostriatal: Causes EPS (i.e. Parkinsonism) 2. Mesolimbic: Relief of psychosis (devil lies down) 3. Mesocortical: Increase in negative symptoms 4. Tuberoinfundibular: Prolactin levels rise (pregnancy symptoms, lose period, engorgement of breasts, pain in brest + lactation, sexual dysfunction) Side Effects: Dopamine & other Receptor Interactions 1. D 2opaminergic: EPS, prolactin release (hyperprolactinemia) 2. H histaminergic: Sedation, weight gain (H1 blockade) 1 3. Muscarinic & cholinergic: Dry mouth, blurred vision, urinary retention, constipation, tachycardia, confusion (Increased doses = mad as a hatter, dry as a bone) 4. Alpha 1 Adrenergic: Orthostatic hypotension, reflex tachycardia 5. Sertonin s2rotonergic wei:ht gain Side Effects: general rules but there are exceptions • More potent D2 receptor antagonists o More EPS o Less side effects at “other” receptors • Less potent D2 receptor antagonists o Less EPS o More side effects at “other” receptors ** Aripiprazole is a partial agonist: don’t get a full response, less block, less movement problems **Haloperidol is blocking fully. Adverse Effects: 1. Neurological: a. EPSE- Extrapyrimidal Symptoms Or Side Effects: 1. Parkinsonism: 2. Akinesia: inner sense of restlessness/ associated with non adherance 3. Bradykinesia: slow motion associated with parkinsonism. 4. Tremor/pin rolling= too much D2 blocker 5. Cogwheel rigidity 6. Shuffling gait 7. Mask like facies 8. Dystonia/ acute dystonia: involuntary spasm affecting neck and jaw typically often described as tetanus- like reaction  Risk Factors: treatment naive, young men, etc  Early reaction:often several hours after first dose to few days  Can be life threatening: laryngeal dystonia can impair respiration (rare: less than 1/1,000  Treatment: anticholinergics act to reverse (benztropine, diphenhydramine- IM/IV) b. Tardive dyskinesia: Slow forming, often with face/hands: need to recognize or else can be permanent  Often irreversible, involuntary movement disorder from long term exposure to D2 blocking agents  Involves face (lip smacking, puckering, tongue protrusions, puffing, frowning), hands and arms (choreoathetoid movements), trunk (writing movements)  4-5% year with conventional antipsychotics  Significantly less with novel agents (“significance” not the same for all of them)  Risk increases with dose, D2 potency, age (older), gender (female), intermittent use pattern, mood disorders  Treatment: no cure, switch to low risk meds (e.g. newer AP’s) c. Neuroleptic malignant syndrome (NMS): rare but potentially life threatening adverse effects Clinical features: 1. Hyperther
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