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]
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]
Thus, 488 484 men were included in the present analyses. [doi.org]
Entire Body System
- Weight Gain
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]
Weight gain Up to 80 percent of patients taking antipsychotic drugs to treat schizophrenia and other mental conditions gain a significant amount of weight. [raysahelian.com]
[…] response. 7 The weight gain in response to antipsychotic medication is also variable. [medsafe.govt.nz]
- Developmental Disorder
Likewise, olanzapine has been evaluated in a pilot study involving children, adolescents, and adults with pervasive developmental disorders. [epilepsy.com]
mood disorders and pervasive developmental disorders or mental retardation. [ncbi.nlm.nih.gov]
- Hypersomnia
Hypersomnia showed a trend to be more common in patients with clozapine (two studies, 266 patients, RR 0.65, CI 0.39 to 1.07). [doi.org]
[…] prescribed off-label, using diagnostic Read code lists, compiled by two clinical academics, a GP and a psychiatrist.18 These non-SMI conditions comprised depression, anxiety disorders, sleep disorders (insomnia, non-specific sleep disorders, apnoea, hypersomnia [bmjopen.bmj.com]
Ahedonia Disturbed sleep pattern – insomnia or hypersomnia Psychomotor retardation or agitation (speech, gait, movements) Exaggerated diminution of self esteem which may be experienced as worthlessness or guilt. [nurseslearning.com]
Gastrointestinal
- Nausea
Both regimens are known for producing nausea and vomiting. [reuters.com]
[…] and vomiting.DB00450DroperidolA butyrophenone derivative and dopamine antagonist used to prevent and treat postoperative nausea and vomiting.DB00477ChlorpromazineA phenothiazine antipsychotic used to treat nausea, vomiting, preoperative anxiety, schizophrenia [drugbank.ca]
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]
[…] tranquilizer (trade name Loxitane) used to treat schizophrenia Moban, molindone antipsychotic drug (trade name Moban) used in the treatment of schizophrenia prochlorperazine antipsychotic and antiemetic drug used to treat schizophrenia and to combat nausea [vocabulary.com]
- Failure to Thrive
[…] to thrive, jitteriness, and EPS in breastfed infants. [ptcommunity.com]
Cardiovascular
- 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]
[…] 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]
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]
hypotension); and family history (e.g., diabetes). [uspharmacist.com]
Musculoskeletal
- 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]
Akathisia (motor restlessness) is particularly unpleasant and may lead to nonadherence; it can be treated with propranolol. [merckmanuals.com]
The nurse may observe this as restlessness or an inability to be still. 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]
Skin
- 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]
[…] motion sickness.DB00372ThiethylperazineFor the treatment or relief of nausea and vomiting.DB00680MoricizineAn antiarrhythmic used to treat arrhythmias.DB01246AlimemazineAn antihistamine agent used to prevent and relieve allergic conditions which cause pruritus [drugbank.ca]
Many of these drugs may also be effective against nausea, emesis, and pruritus. [ncbi.nlm.nih.gov]
• Prometathazine is not a good antipsychotic drug, but the agent is used in treating pruritus because of its antihistaminic properties. Mohsin Aziz 37 38. Mohsin Aziz 38 [slideshare.net]
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]
- 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]
Psychiatrical
- Delusion
The condition often includes hallucinations or delusions. When experiencing hallucinations, the patient often hears voices that aren’t actually there, while delusions related to psychosis consist of feelings or ideas that aren’t based on reality. [psychguides.com]
Antipsychotics are drugs that are used to treat symptoms of psychosis such as delusions (for example, hearing voices), hallucinations, paranoia, or confused thoughts. [drugs.com]
These include hallucinations (sights, sounds, smells, tastes, or touches that a person believes to be real but are not real), delusions (false beliefs), and dementia (loss of the ability to think, remember, learn, make decisions, and solve problems). [cancer.gov]
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]
Antipsychotic Agents relieve and control the symptoms of schizophrenic illness (hallucinations, delusions, dementia). [fpnotebook.com]
- Withdrawn
In this case, the medication should be withdrawn and substituted for an alternative. [news-medical.net]
Antipsychotics can be safely withdrawn from many dementia patients in long-term care facilities. The drugs can be withdrawn and supplanted with behavior-centered care. [raysahelian.com]
Sixty-five patients were on 300 mg of chlorpromazine at the start of the study, and 54% of those patients worsened after the drug was withdrawn. [madinamerica.com]
A comprehensive review that analyzed 66 studies found a mean cumulative relapse rate of 53% in patients withdrawn from neuroleptic therapy compared to 16% for those maintained on a regimen of neuroleptic therapy over a mean follow-up period of 9.7 months [doi.org]
I ++++ ++++ ++++ ++++ ++++ Fluphenazine (Prolixin) T, L, I, I (LA) ++++ ++ + + ++ Perphenazine (Trilafon) T ++++ ++++ + ++ +++ Trifluoperazine (Stelazine) T ++++ +++ + ++ ++ Thioridazine (Mellaril) T ++++ ++++ ++++ ++++ ++++ Mesoridazine (Serentil) +withdrawn [psychopharmacologyinstitute.com]
- Stereotyped Behavior
Lurasidone showed potent effects predictive of antipsychotic activity, such as inhibition of methamphetamine-induced hyperactivity and apomorphine-induced stereotyped behavior in rats, similar to other antipsychotics. [ncbi.nlm.nih.gov]
COPYRIGHT 2001 KIPO (KO) 본 발명은 항정신병 치료제로 유효한 폴리갈라사포닌계 화합물에 관한 것으로서, 더욱 상세하게는 원지() 추출물로부터 분리 분획된 것으로 기존 항정신병 약물의 행동 약리학적 특성인 아포모르핀(apomorphine)에 의하여 유발된 상동적 행동(stereotyped behaviors)과 등반 행동(climbing behaviors)을 억제하는 활성을 가지는 폴리갈라사포닌계 화합물의 항정신병 치료제로서의 용도에 [patentscope.wipo.int]
Neurologic
- Agitation
[…] 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
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]
Akathisia can be acute or chronic, occurring in a tardive form with symptoms that last >6 months. 1-3 Much isn’t known about drug-induced akathisia Our understanding of the pathophysiology of akathisia is incomplete. [mdedge.com]
A 2010 review concluded that, “Effective and well-tolerated treatment is a major unmet need in akathisia.” [psychcentral.com]
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]
- Seizure
[…] medication inducing seizure activity. [ncbi.nlm.nih.gov]
All antipsychotic medications decrease the seizure threshold to varying degrees. [epilepsy.com]
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]
All antipsychotics can lower the seizure threshold. Nonetheless, overall, seizures are relatively rare. [clinicaladvisor.com]
- Dystonia
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]
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]
Laryngeal dystonia Lorazepam 4 mg IV over 10 minutes, then 1–2 mg IV slowly Intubation may be needed. [msdmanuals.com]
- Catatonia
[…] early 1930s by Baruk and De Jong demonstrating an experimental induction of catatonia with agents such as bulbocapnine and later with mescaline and other psychotogenic agents. [springerlink.com]
Individuals develop a severe rigidity with catatonia, autonomic instability, and stupor, which may persist for more than one week. [britannica.com]
Mark Brown and Scott Freeman, Clonazepam Withdrawal-Induced Catatonia, Psychosomatics, 50, 3, (289), (2009). [doi.org]
Workup
Anterior chamber cell Keratic Precipitates Flare Hypopyon Iris nodules Posterior synechiae Fibrin Pupillary miosis Band keratopathy Diagnostic procedures The basic workup for acute anterior uveitis includes an HLA-B27, syphilis testing, and testing for [eyewiki.aao.org]
Serum
- 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]
[…] tachypnea, diaphoresis, dysrhythmias) Mental status change: confusion, delirium, reduced vigilance, stupor Diagnostics ↑↑ Creatine kinase Leukocytosis ↑ Transaminases Metabolic acidosis Myoglobinuria Electrolyte abnormalities (hypocalcemia, hyperkalemia, hyponatremia [amboss.com]
Greenblatt, Antidepressant-Associated Hyponatremia in the Elderly, Journal of Clinical Psychopharmacology, 36, 6, (545), (2016). [doi.org]
QT, RR, ST Intervals
- 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]
Smaller increase in prolactin levels compared to typical antipsychotics Most common in risperidone, amisulpride, and paliperidone Prolonged QT interval Potassium channel-mediated effect Can lead to life-threatening arrhythmias (torsades de pointes and [amboss.com]
All patients who receive atypical antipsychotics need to understand their adverse effects, including weight gain, prolonged Qt interval, diabetes, sedation, and the risk of dyskinesias. [ncbi.nlm.nih.gov]
Furthermore, a pharmacodynamic drug interaction may be the result of combining two or more drugs with established risk of prolongation of corrected QT interval (QTc), such as chlorpromazine and haloperidol [ 11, 13 ]. [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
References http://psychcentral.com/lib/schizophrenia-treatment/ http://emedicine.medscape.com/article/288259-treatment#d9 http://patient.info/health/schizophrenia-leaflet http://www.mayoclinic.org/diseases-conditions/schizophrenia/basics/treatment/con [news-medical.net]
One form of convulsive treatment, called electroconvulsive treatment (ECT), is used today, but not to treat schizophrenia. [bap.org.uk]
Furthermore, increase in body weight is unlikely to be prediction of therapeutic response to antipsychotic treatment in schizophrenia. [ncbi.nlm.nih.gov]
But what the trials show is that many doctors, when they see a patient improve on treatment, assume that it is the treatment that has produced the benefit without asking the patient whether they can detect anything useful the treatment is doing. [rxisk.org]
Prognosis
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]
Uveitis is classified by anatomical location which correlates with etiology and affects treatment as well as prognosis (see Figure 1). [cancertherapyadvisor.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]
Prognosis Some forms of AAU have a tendency to recur. [eyewiki.aao.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]
Uveitis is classified by anatomical location which correlates with etiology and affects treatment as well as prognosis (see Figure 1). [cancertherapyadvisor.com]
[…] symptoms (EPS) Definition: : a collection of movement disorders that are typically due to disruption of dopaminergic pathways in the basal ganglia, resulting in bradykinesia, rigidity, dystonia, athetosis, chorea, ballismus, akathisia, tics, and tremors Etiology [amboss.com]
Etiological differential Diagnosis 31 32. “ 32 Feature Granulomatous Uveitis Non-granulomatous Uveitis 1. Onset Insidious Acute 2. Pain Minimal Marked 3. Photophobia Slight Marked 4. Ciliary congestion minimal Marked 5. [slideshare.net]
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]
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]
DESIGN: Retrospective, epidemiologic survey of spontaneously reported adverse events related to olanzapine therapy SETTING: Government-affiliated drug evaluation center. [ncbi.nlm.nih.gov]
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]
These drugs have also proved to be of great value in studying the pathophysiology of schizophrenia and other psychoses. [accessmedicine.mhmedical.com]
Prevention
They are usually taken as part of a long-term management plan, as they help to prevent relapses of psychotic episodes. [news-medical.net]
It is important to clarify whether olanzapine could have a role in long-term prevention of manic and depressive relapses. [ncbi.nlm.nih.gov]