Effects of Antipsychotics

Effects of antipsychotics:

1. Acute Neuroleptic Malignant Syndrome (NMS) :

Neuroleptic malignant syndrome (NMS) is a potentially fatal side effect of antipsychotic drugs, characterised by severe rigidity, fever, altered mental status and autonomic dysfunction. It is more common with first generation or typical antipsychotics; however, it has been reported with all classes of atypical antipsychotics as well. Risk factors for NMS include high AP dose ,flu like symptoms preceeding the onset of NMS, rapid escalation of dosing schedule, rapid/startling dosing schedule or previous NMS episodes. There are multiple reports of increased prevalence in patients treated with atypicals versus conventional neuroleptics.

2. Neurocognitive impairment :

Negative effects of both typical and atypical antipsychotics on cognition are well documented in schizophrenia patients, irrespective of disease stage. Trials have shown that the effect is independent of the level of neurological disturbance or severity of psychosis, though they tend to be more pronounced in acutely psychotic patients. Atypical neuroleptics seems to cause more cognitive impairment than older conventional agents. There are emerging hypotheses about possible mechanism for this cognitive impairment with some studies suggesting dopamine receptor antagonism in cortex , especially medial prefrontal cortex may be responsible for it .The exact mechanisms remain still unclear but newer research suggests that atypicals could block NMDA glutamate receptors which further inhibits GABA neurotransmitter system which is responsible for memory .

On the other hand, it has also been suggested that atypicals with serotonin antagonism (risperidone) may be less likely to cause cognitive impairment than those without serotonin antagonism (haloperidol).

3. Metabolic Syndrome :

Atypical antipsychotics are likely to induce metabolic syndrome that is not seen with conventional neuroleptic drugs like haloperidol or even clozapine. Sudden weight gain, changes in glucose levels and unusual change in lipid profile are considered as typical symptoms of this syndrome. This could lead to cardiovascular diseases, hypertension and diabetes later on . There have been few reports of increased risk of mortality associated with metabolic side effects ,independent of any cardiac or diabetic complications.

4. Neuroleptic Malignant Syndrome (NMS) :

Neuroleptic malignant syndrome (NMS) is a potentially fatal side effect of antipsychotic drugs, characterised by severe rigidity, fever, altered mental status and autonomic dysfunction. It is more common with first generation or typical antipsychotics; however, it has been reported with all classes of atypical antipsychotics as well. Risk factors for NMS include high AP dose ,flu like symptoms preceeding the onset of NMS, rapid escalation of dosing schedule, rapid/startling dosing schedule or previous NMS episodes. There are multiple reports of increased prevalence in patients treated with atypicals versus conventional neuroleptics.

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5. Tardive dyskinesia (TD) :

Tardive dyskinesia (TD) is a potentially irreversible movement disorder caused by long-term use of antipsychotic drugs, characterised by involuntary movements of the tongue, lips, face and extremities. The risk of developing TD increases with the duration of exposure and is highest among those treated with high doses of antipsychotics for more than 5 years. Although all atypical antipsychotics are associated with TD, it seems to be less common with clozapine and quetiapine than other agents. There are few reports of increased incidence of TD with olanzapine and risperidone.

6. Agranulocytosis:

Agranulocytosis is a rare but potentially fatal side effect of antipsychotic drugs, characterised by a severe drop in the number of white blood cells. The risk of developing agranulocytosis increases with the duration of exposure and is highest among those treated with high doses of antipsychotics for more than 6 months. Clozapine is the most commonly implicated drug in causing this side effect, though it has also been reported with all atypical antipsychotics.

7. Extrapyramidal Symptoms (EPS) :

Extrapyramidal symptoms (EPS) are a group of movement disorders that are common with antipsychotic drugs, and include dystonia, akathisia, parkinsonism and tardive dyskinesia. They are caused by the blocking of dopamine receptors in the brain. All atypical antipsychotics are associated with EPS, but they seem to be less common with clozapine and quetiapine than other agents. There is an increased risk of EPS with high doses of atypical antipsychotics.

8. QT Prolongation:

QT prolongation is a potentially life-threatening side effect of all antipsychotic drugs, characterised by a lengthening of the QT interval on thecardiogram (ECG). The risk of developing QT prolongation increases with the dose and duration of exposure to antipsychotics. Clozapine is the most commonly implicated drug in causing this side effect, though it has also been reported with all atypical antipsychotics.

9. Hypersensitivity Reactions:

Hypersensitivity reactions are a group of adverse effects that occur as a result of an immune response to a drug. They can range from mild skin rashes to life-threatening anaphylactic reactions. All atypical antipsychotics are associated with hypersensitivity reactions, but they seem to be less common with clozapine and quetiapine than other agents. There is an increased risk of hypersensitivity reactions with high doses of atypical antipsychotics.

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10. Blood Dyscrasias:

Blood dyscrasias are a group of adverse effects that occur as a result of a disruption of the normal production and function of blood cells. They can range from mild anemia to life-threatening aplastic anaemia or agranulocytosis. All atypical antipsychotics are associated with blood dyscrasias, but they seem to be less common with clozapine and quetiapine than other agents. There is an increased risk of blood dyscrasias with high doses of atypical antipsychotics.

How do antipsychotics work:

There is still some debate over how antipsychotics work, but the general consensus is that they block dopamine receptors in the brain. This reduces the amount of dopamine present in the brain, which helps to control the symptoms of psychosis.

Some experts also believe that antipsychotics may help to improve the function of certain regions of the brain that are thought to be involved in psychosis. For example, they may help to improve communication between different parts of the brain and increase the activity of nerve cells.

However, it is still not clear exactly how antipsychotics work and more research is needed to determine this.

Types of antipsychotics:

There are a number of different types of antipsychotic medication available, each of which works in a slightly different way.

The most common types of antipsychotic medication include:

• typical antipsychotics – these work by blocking dopamine receptors in the brain

• atypical antipsychotics – these work by blocking dopamine and serotonin receptors in the brain

• depot antipsychotics – these are long-acting medications that are injected into the body every few weeks or months

Some people may be prescribed more than one type of antipsychotic medication, depending on their individual needs.

Side effects of antipsychotics:

Like all medications, antipsychotics can cause side effects. The most common side effects include:

• drowsiness

• dizziness

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• dry mouth

• constipation

• weight gain

Some people may also experience more serious side effects, such as:

• movement disorders, such as Parkinson’s disease or tardive dyskinesia

• heart problems

• seizures

• skin problems, such as rashes or acne

It is important to discuss the potential side effects of antipsychotic medication with your doctor before starting treatment.

Outpatient and inpatient treatment:

Antipsychotic medication is usually prescribed on an outpatient basis, which means that you will take it at home. However, in some cases it may be necessary for you to be admitted to hospital for a short period of time so that your medication can be monitored.

Your doctor will be able to advise you about the best course of treatment for you.

Antipsychotic medication is a type of medication that is used to treat psychosis. It works by blocking dopamine receptors in the brain, which helps to control the symptoms of psychosis.

There are a number of different types of antipsychotic medication available, each of which works in a slightly different way. The most common types of antipsychotic medication include:

• typical antipsychotics – these work by blocking dopamine receptors in the brain

• atypical antipsychotics – these work by blocking dopamine and serotonin receptors in the brain

• depot antipsychotics – these are long-acting medications that are injected into the body every few weeks or months

Some people may be prescribed more than one type of antipsychotic medication, depending on their individual needs.

Side effects of antipsychotics for schizophrenia:

Like all medications, antipsychotics can cause side effects. The most common side effects include:

• drowsiness

• dizziness

• dry mouth

• constipation

• weight gain

Some people may also experience more serious side effects, such as:

• movement disorders, such as Parkinson’s disease or tardive dyskinesia

• heart problems

• seizures

• skin problems, such as rashes or acne

outpatient and inpatient treatment of schizophrenia:-Antipsychotic medication is usually prescribed on an outpatient basis, which means that you will take it at home. However, in some cases, it may be necessary for you to be admitted to the hospital for a short period of time so that your medication can be monitored.

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