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Antipsychotic Agent

Agents Antipsychotic


Presentation

  • Reasons of psychiatrists to switch to olanzapine were the expectation of better efficacy and tolerability of the present treatment and patient preferences to continue with the present medication.[ncbi.nlm.nih.gov]
  • II is an active metabolite that was present in all species.[ncbi.nlm.nih.gov]
  • The number, size and reporting of randomised controlled perazine trials are insufficient to present firm conclusions about the properties of this antipsychotic.[ncbi.nlm.nih.gov]
  • Thus, 488 484 men were included in the present analyses.[doi.org]
  • This study will compare four atypical antipsychotic medications in terms of the risk of specific side effects each of them presents in middle-aged and elderly individuals.[clinicaltrials.gov]
Weight Gain
  • CONCLUSION: The TaqI A polymorphism of DRD2 gene is therefore unlikely to play an important role in antipsychotic agent-induced weight gain, a side effect of antipsychotic treatment.[ncbi.nlm.nih.gov]
  • Important strategies for minimizing weight gain in patients taking antipsychotic agents include improving negative symptoms of avolition and apathy, regular monitoring of body weight and potential medical consequences of overweight and obesity, and educating[ncbi.nlm.nih.gov]
  • Gain, Diabetes, and Lipid Abnormalities: Weight gain is a substantially significant side effect of antipsychotic agents and is frequently reported in both adults and children. 12,13 Olanzapine and clozapine cause more weight gain than other atypical[uspharmacist.com]
  • We proposed that a mechanism for atypical antipsychotic-induced weight gain may be partly through the H3 receptor, as a drug-induced decrease in H1 receptor activity may decrease histamine tone through the H3 autoreceptors, compounding the weight gain[ncbi.nlm.nih.gov]
Turkish
  • T102C and -1438 G/A polymorphisms of the 5-HT2A receptor gene in Turkish patients with obsessive-compulsive disorder. Eur Psychiatr. 2003; 18 (5):249–254. [ PubMed : 12927326 ] 27. Pornnoppadol C, et al.[ncbi.nlm.nih.gov]
Nausea
  • They can be beneficial in the control of nausea, in the treatment of intractable hiccups, in controlling the movement disorders associated with Huntington's chorea and Gilles de la Tourette's syndrome, and, in combination with other drugs, for the control[medical-dictionary.thefreedictionary.com]
  • Gastrointestinal Effects: Constipation, dry mouth, anorexia, weight gain, increases in pancreatic enzymes, epigastric distress, abdominal cramps, dyspepsia, heartburn, and nausea are some common adverse effects.[goodtherapy.org]
  • Withdrawal of these agents can cause nausea, emesis, anorexia, diarrhea, rhinorrhea, diaphoresis, myalgia, paresthesia, anxiety, agitation, restlessness, and insomnia.[ncbi.nlm.nih.gov]
  • […] initial brand names and date of first approval) include chlorpromazine (Thorazine: 1957, the initial prototype antipsychotic agent), fluphenazine (Prolixin: 1972), perphenazine (Trilafon: 1957), prochlorperazine (Compazine: 1956, used mostly as therapy of nausea[livertox.nih.gov]
  • Akathisia, extrapyramidal symptoms, somnolence, nausea, vomiting, diarrhea, and anxiety were the most common adverse events for patients taking lurasidone as a monotherapy.[medscape.com]
Orthostatic Hypotension
  • Adverse effects include orthostatic hypotension, tachycardia, benign hyperthermia, hypertension, seizures, and sedation. Many of these effects are transient.[ncbi.nlm.nih.gov]
  • Adverse effects Extrapyramidal effects (dystonia, akathisia, parkinsonism), tardive dyskinesia due to blocking of basal ganglia; sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation[medical-dictionary.thefreedictionary.com]
  • ., drug-related orthostatic hypotension); and family history (e.g., diabetes).[uspharmacist.com]
  • Orthostatic hypotension—the medical name for the fuzzy feeling you get when standing up to quickly—is very common. Hepatic (Liver) Effects: These agents increase the serum concentration of alkaline aminotransferase.[goodtherapy.org]
  • […] prevent orthostatic hypotension The nurse has just given a client 5 mg of Haldol IM. The nurse tells him that he should lie down for at least 30 min. This will help...with the distribution of the drug or prevent orthostatic hypotension.[quizlet.com]
Pruritus
  • Many of these drugs may also be effective against nausea, emesis, and pruritus. Definition (NCI) Also known as neuroleptics, major tranquilizers, or antischizophrenics, natural or synthetic.[fpnotebook.com]
  • An important reason for this inequality may be that—notably mild—hypothermia tends to present with rather subtle and atypical symptoms, such as confusion, vertigo, nausea, hunger, chills, pruritus, and dyspnea ( 4 ) and may, therefore, easily go unnoticed[doi.org]
  • Kevin Chun-Kai Wang, Pruritus in Older Patients, Advances in Geriatric Dermatology, 10.1007/978-3-319-18380-0_2, (31-39), (2015).[dx.doi.org]
Alopecia
  • Patients presented with findings such as hirsutism, acne, alopecia, menstrual abnormalities, acne, acanthosis nigricans and central obesity.[healio.com]
  • Three cases of alopecia areata induced by zotepine. Acta Neurol Napoli 1993 Jun; 15: 200–3 PubMed Google Scholar 101. Reynolds JEF, editor. Martindale: the extra pharmacopoeia. 31st ed.[doi.org]
Decreased Sweating
  • These include dry mouth, decreased sweating, constipation and dry eyes. Somnolence and low blood pressure are common.[encyclopedia.com]
Motor Restlessness
  • The patient factors include mild severity of akathisia, lack of apparent motor restlessness, no voluntary expression of inner restlessness, no clear communication of inner restlessness, restlessness in body parts other than the legs, atypical expressions[doi.org]
  • Extrapyramidal effects: Dystonias (sustained contraction of muscles leading to twisting, distorted postures), Parkinson-like symptoms, akathisia (motor restlessness), and tardive dyskinesia (involuntary movements, usually of the tongue, lips, neck, trunk[brilliantnurse.com]
  • Akathisia can be described as a subjective sense of unease and motor restlessness. It can be misinterpreted as increasing agitation or anxiety.[clinicaladvisor.com]
  • The patient’s motor restlessness is visable and is subjectively experienced as anxiety, or agitation. Akathesia may develop weeks or months after the onset of drug therapy.[nurseslearning.com]
  • Significant improvements in overall symptoms of autism, motor restlessness/hyperactivity, social relatedness, affectual reactions, sensory responses, language usage, self injury, aggression, irritability or anger, anxiety, and depression were observed[ncbi.nlm.nih.gov]
Delusion
  • Delusions and hallucinations are often modified and may be eliminated by such an agent, but once the drug is discontinued, the delusions and hallucinations often return within a short while.[medical-dictionary.thefreedictionary.com]
  • Positive symptoms include hallucinations, voices that converse with or about the patient, and delusions that are often paranoid. Negative symptoms include flattened affect, loss of a sense of pleasure, loss of will or drive, and social withdrawal.[ncbi.nlm.nih.gov]
  • Positive symptoms include auditory hallucinations, delusions, and thought disorder. Negative symptoms (demotivation, self-neglect, and reduced emotion) have not been consistently improved by any treatment.[ncbi.nlm.nih.gov]
  • They sedate, or tranquillise, the emotions, so reducing the anxiety of paranoia and delusions. Any person on antipsychotics is likely to verify this (go to askapatient.com ). Now, however, these drugs are referred to as "antipsychotics".[web.archive.org]
Agitation
  • ChEBI Name antipsychotic agent ChEBI ID CHEBI:35476 Definition Antipsychotic drugs are agents that control agitated psychotic behaviour, alleviate acute psychotic states, reduce psychotic symptoms, and exert a quieting effect.[ebi.ac.uk]
  • They are also effective in helping to control agitation and aggressiveness.[medical-dictionary.thefreedictionary.com]
  • […] rapidly-acting pharmacologic options for acute agitation are outlined in Table 1.[ncbi.nlm.nih.gov]
  • Medications used to treat agitation include antipsychotics and benzodiazepines, usually administered intramuscularly when rapid action is desired.[doi.org]
Akathisia
  • Side effects such as a discomforting restlessness and agitation ( akathisia ), involuntary rhythmic movements of the trunk and limbs, parkinsonism, and tardive dyskinesia are often misinterpreted as symptoms of some unrelated disorder; these are often[medical-dictionary.thefreedictionary.com]
  • She was rated on Barnes Akathisia Rating Scale (BAS) and on global clinical assessment for akathisia, she was rated as four, indicative of marked akathisia.[ncbi.nlm.nih.gov]
  • Abstract This article reviews what causes clinicians to overlook or underdiagnose akathisia. The causes are considered to be related to both the patient's symptoms and the clinician's attitude toward akathisia.[doi.org]
  • In a multiple regression model adjusted for confounders, akathisia was less common with low potency agents.[ncbi.nlm.nih.gov]
  • , and 1 for both parkinsonism and akathisia).[ncbi.nlm.nih.gov]
Seizure
  • .), hypotension, tachycardia and precipitation of epileptic seizures, which occur with the older antipsychotic drugs, have also been reported with loxapine.[ncbi.nlm.nih.gov]
  • Adverse effects include orthostatic hypotension, tachycardia, benign hyperthermia, hypertension, seizures, and sedation. Many of these effects are transient.[ncbi.nlm.nih.gov]
  • People who take antipsychotic medications may experience negative side effects, such as: Extrapyramidal Effects: Dystonias, akathisia, tardive dyskinesia, Parkinson’s-like symptoms, unwanted movements, ataxia, muscle breakdown, rigidity, tremors, and seizures[goodtherapy.org]
  • […] this concept, clinicians should tailor the antipsychotic medication regimen to the individual, incorporating pertinent information to help in selecting an appropriate antipsychotic agent, such as medical history (cardiac or cerebrovascular disease, seizure[uspharmacist.com]
  • […] medication inducing seizure activity.[ncbi.nlm.nih.gov]
Dystonia
  • Adverse effects Extrapyramidal effects (dystonia, akathisia, parkinsonism), tardive dyskinesia due to blocking of basal ganglia; sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation[medical-dictionary.thefreedictionary.com]
  • With the discovery of clozapine in 1959, it became evident that this drug was less likely to produce extrapyramidal effects (physical symptoms such as tremors, paranoia, anxiety, dystonia, etc. as a result of improper doses or adverse reactions to this[goodtherapy.org]
  • Desarker and Sinha[ 4 ] reported a case of quetiapine-induced akathisia and dystonia in a young male receiving 400 mg/day of quetiapine, which subsided after change of drug to aripiprazole (10 mg/day).[ncbi.nlm.nih.gov]
  • RESULTS: There were no significant differences in incidence or change in rating scales for parkinsonism, dystonia, akathisia or tardive dyskinesia when comparing second-generation antipsychotics with perphenazine or comparing between second-generation[ncbi.nlm.nih.gov]
  • There is currently no cure for dystonia, but there are several popular treatments depending on the type of dystonia and age of onset.[psychcentral.com]
Stupor
  • Individuals develop a severe rigidity with catatonia, autonomic instability, and stupor, which may persist for more than one week.[britannica.com]
  • Neuroleptic malignant syndrome: This potentially fatal reaction to antipsychotic drugs is characterized by muscle rigidity, fever, altered mental status and stupor, unstable blood pressure, and myoglobinemia.[brilliantnurse.com]
  • However, only two patients reported serious adverse events, including stupor, anxiety, irritability, and akathisia, which were considered to be related to treatment with blonanserin. 31 The most frequent adverse reactions with blonanserin were EPS, which[ncbi.nlm.nih.gov]
  • Levels of consciousness may vary; however, stupor and even coma are not uncommon.[nurseslearning.com]

Workup

  • Rett’s disorder and CDD, which differ greatly from the other PDDs in terms of their diagnostic workup and clinical course, are rare.[ncbi.nlm.nih.gov]
Hyponatremia
  • Clemastine Carbinoxamine Chronic constipationa Clomipramine Carboplatin SIADH or hyponatremia Clonazepam Clemastine (various) Chronic constipation Dabigatran Clozapine Chronic seizures or epilepsy Desiccated thyroid Cisplatin SIADH or hyponatremia Dexbrompheniramine[ncbi.nlm.nih.gov]
  • Greenblatt, Antidepressant-Associated Hyponatremia in the Elderly, Journal of Clinical Psychopharmacology, 36, 6, (545), (2016).[dx.doi.org]
Prolonged QT Interval
  • QT interval Baseline electrocardiography if patient has history of heart disease, syncope, sudden death in a family member younger than 40 years, congenitally prolonged QT interval, or polypharmacy Table 4.[aafp.org]
  • Side-effects include a prolonged QT interval in the heart, which can be dangerous for patients with heart disease or those taking other drugs that prolong the QT interval. Melperone † – Only used in a few European countries.[en.wikipedia.org]
  • Strong inhibitors of CYP3A4 like erythromycin, ketoconazole, itraconazole and grape fruit juice have caused elevated substrate levels that have precipitated prolonged QT interval, torsades de pointes and even death [ 52 ].[omicsonline.org]
  • Side-effects include a prolonged QT interval in the heart, which can be dangerous for patients with heart disease or those taking other drugs that prolong the QT interval. Amisulpride (Solian) - Selective dopamine antagonist.[marefa.org]

Treatment

  • Furthermore, increase in body weight is unlikely to be prediction of therapeutic response to antipsychotic treatment in schizophrenia.[ncbi.nlm.nih.gov]
  • Current data suggest that olanzapine may be more effective than haloperidol for the treatment of negative symptoms; moreover, preliminary data suggest that fewer relapses occur over the course of treatment in patients treated with olanzapine compared[ncbi.nlm.nih.gov]
  • Thirty min before performing the behavioral tasks, adult male CF-1 mice were administered aripiprazole (1, 3 or 10 mg/kg, ip) once for the acute treatment, or the same doses for 5 d for the subchronic treatment.[ncbi.nlm.nih.gov]
  • BACKGROUND: Polypharmacy for schizophrenia treatment is not justified by the available clinical evidence.[ncbi.nlm.nih.gov]
  • The inability of anticancer agents to cross the blood-brain-barrier represents a critical challenge for successful treatment.[ncbi.nlm.nih.gov]

Prognosis

  • […] versatile mechanisms of tumoricidal actions and due to its highly traversing capability through the blood-brain barrier, pimozide highly deserves to be studied in animal models of drug resistant refractory cancers and glioblastoma, which have very poor prognosis[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The expected improvement in EPS profiles for participants randomised to second-generation drugs was not found; the prognosis over 1 year of those in the first-generation arm was no worse in these terms.[ncbi.nlm.nih.gov]
  • […] of poorly tolerated side effects, using an alternative medication should be considered in light of the variety of antipsychotics currently available. 2 Patient and family counseling should take place, including education about the illness, symptoms, prognosis[uspharmacist.com]
  • Prognosis In general, patients who arrive alive at health care facilities have a very good prognosis. Most deaths from these agents occur in the prehospital period. Thus, if an individual survives to hospital admission, the prognosis is quite good.[clinicaladvisor.com]
  • The central role of prognosis in clinical decision making. JAMA. 2012 Jan 11;307(2):199-200. Gross CP. Cancer screening in older persons: a new age of wonder. JAMA Intern Med. 2014 Oct;174(10):1565-7. Lee SJ, Leipzig RM, Walter LC.[choosingwisely.org]

Etiology

  • Abstract Schizophrenic illness is associated with high rates of osteoporosis, the etiology of which remains obscure, but which may be at least partly explained by the prolactin-raising properties of antipsychotic medication.[ncbi.nlm.nih.gov]
  • BACKGROUND: Polyunsaturated fatty acid (PUFA) metabolism abnormalities have been long implicated in the etiology of schizophrenia.[ncbi.nlm.nih.gov]
  • These etiological groups are thought to have different (albeit partly overlapping) pathophysiological mechanisms.[doi.org]
  • Neuroleptics have two common uses in patients with developmental disabilities and epilepsy: They are the primary pharmacologic intervention for patients with a psychotic disorder resulting from a primary psychiatric or an organic etiology.[epilepsy.com]
  • Diagnostic approach History is the essential in determining the etiology of the symptoms. Certainly aggressive supportive care is key, and patient care should not be delayed while trying to obtain a history.[clinicaladvisor.com]

Epidemiology

  • Caleb Alexander, MD, MS, Johns Hopkins School of Public Health, Department of Epidemiology, 615 N. Wolfe Street W6035, Baltimore, MD 21205, USA.[doi.org]
  • Psychiatric epidemiology and the classification of mental disorder . International Journal of Epidemiology 11 , 312 – 314 . Shmaonova , L. M. ( 1983 ). Possibilities of the epidemiological method and results of population studies on schizophrenia .[doi.org]
  • Uçar HN, Eray S, Kocael Ö, Uçar L, Kaymak M, Lettieri E & Vural AP PDF INTERNET SEARCHES FOR “SUICIDE”, ITS ASSOCIATION WITH EPIDEMIOLOGICAL DATA AND INSIGHTS FOR PREVENTION PROGRAMS Waszak PM, Górski P, Springer J, Kasprzycka-Waszak W, Duzy M & Zagozdon[hdbp.org]
  • OBJECTIVE: To review empirical studies that assess outcome of patients with schizophrenia and evaluate the degree to which reported outcome is affected by research methodology, treatment variables, prognostic factors, epidemiologic factors, and patient[ncbi.nlm.nih.gov]
  • DESIGN: Retrospective, epidemiologic survey of spontaneously reported adverse events related to olanzapine therapy SETTING: Government-affiliated drug evaluation center.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • CI-686's unique preclinical profile suggests a mechanism of action other than dopamine antagonism which could have implications regarding current thinking on the pathophysiology of schizophrenia.[ncbi.nlm.nih.gov]
  • These efforts should be based on the pathophysiology of the diseases and the affected neurotransmitter systems.[doi.org]
  • This mechanism may normalise glutamatergic dysfunction and structural abnormalities and affect the core pathophysiological substrates for schizophrenia.[ncbi.nlm.nih.gov]
  • Functional brain imaging has, after only a few years of application, made significant contributions to our understanding of the pathophysiology of schizophrenia.[ncbi.nlm.nih.gov]

Prevention

  • It is important to clarify whether olanzapine could have a role in long-term prevention of manic and depressive relapses.[ncbi.nlm.nih.gov]
  • Polarity Index was retrieved by calculating Number Needed to Treat (NNT) for prevention of depression and NNT for prevention of mania ratio, as emerging from the results of randomized placebo-controlled trials.[ncbi.nlm.nih.gov]
  • There are no established drug treatments to prevent or counter these problems.[ncbi.nlm.nih.gov]
  • The results clearly demonstrate the superiority of antipsychotic drugs compared to placebo in preventing relapse. This effect must be weighed against the side effects of antipsychotic drugs.[ncbi.nlm.nih.gov]

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