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Schizophrenia (MEDICAL MANAGEMENT
The primary treatment for schizophrenia is psychopharmacology. Antipsychotic medications, also known as neuroleptics, are prescribed to decrease psychotic symptoms. Conventional antipsychotics target positive symptoms like delusions and hallucinations by blocking dopamine, while atypical antipsychotics also target negative symptoms by blocking serotonin. Common side effects of antipsychotics include extrapyramidal symptoms like dystonia, akathisia, and tardive dyskinesia. Clozapine is effective but carries the risk of the potentially fatal agranulocytosis if white blood cell counts are not regularly monitored. Long-acting injectable forms of fluphenazine and haloperidol can be used for maintenance therapy
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Schizophrenia (MEDICAL MANAGEMENT
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- 2. Psychopharmacology The primary medicaltreatment for schizophrenia is PSYCHOPHARMACOLOGY. In the past: Electroconvulsive therapy Insulin Shock therapy Psychosurgery
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- 6. 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.
- 7. Conventional Antipsychotics These drugsare 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
- 8. Atypical Antipsychotics These drugsare 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
- 9. Maintenance Therapy areavailable in depot injection forms. Two medications are available in depot injection forms for maintenance therapy: Fluphenazine (PROLIXIN) in decanoate Haloperidol (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.
- 10. SIDE EFFECTS: Serious neurologicside effects include : Extrapyramidal side effects Acute dystonic reactions Akathisia Parkinsonism/ Pseudo parkinsonism Tardive Dyskinesia Seizures Neuroleptic Malignant Syndrome
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- 12. Extrapyramidal Side effects: EPSare 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.
- 13. Pseudoparkinsonism PSEUDOPARKINSONISM or Neuroleptic-induced parkinsonism, includesshuffling gait, mask like Facies, muscle stiffness or cogwheeling rigidity and drooling.
- 14. AKATHISIA Characterized by restlessmovement, 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.
- 15. Tardive Dyskinesia Alate 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.
- 16. Tardive Dyskinesia Clozapine (Clozaril), anatypical 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.
- 17. Screening clients forlate appearing movement disorder – important!
- 18. ABNORMAL INVOLUNTARY MOVEMENTSCALE * 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.
- 19. Seizures are anSEIZURE 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.
- 20. Neuroleptic Malignant Syndrome 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.
- 21. Agranulocytosis Clozapine has thepotentially 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.
- 22. Agranulocytosis • WBC mustbe 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.
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