Download Drugs for Psychoses

Drugs for Psychoses
Expanded Key Concepts
17.1 Psychoses are severe mental and behavioral disorders characterized by disorganized
mental capacity and an inability to recognize reality.
Psychoses are a severe form of mental disease, characterized by loss of touch with reality. Both
acute and chronic psychoses require long-term drug therapy for the patient to perform normal,
productive daily functions.
17.2 Schizophrenia is a type of psychosis characterized by abnormal thoughts and thought
processes, disordered communication, and withdrawal from other people and the outside
environment. High risk for suicide is also prevalent.
The most common type of psychosis is schizophrenia. Schizo-affective disorder is characterized
by psychosis and mood disorder. The biological basis for schizophrenia focuses on dopamine
receptors in the brain that are targets for antipsychotic medications. Patients diagnosed with
psychosis are treated based on the expression of positive and negative psychotic symptoms.
17.3 Pharmacologic management of psychoses is difficult because the adverse effects of the
drugs may be severe and patients often do not understand the need for medication.
Pharmacotherapy of psychoses is often challenging. Compliance is a major problem, as patients
often do not believe they need to continue taking a medication that produces so many side
effects. The selection of a specific antipsychotic medication is based upon the needs of the
patient and the experience of the mental health clinicians. Since all are equally efficacious, the
spectrum of side effects often determines drug choice.
17.4 The phenothiazines have been effectively used for the treatment of psychoses for over 50
years, however they have a high incidence of side effects. Extrapyramidal side effects (EPS) and
neuroleptic malignant syndrome (NMS) are two particularly serious conditions.
The phenothiazines are the oldest and largest class of antipsychotics. They are efficacious at
relieving the hallucinations and delusions associated with schizophrenia, but produce many
adverse effects. Extrapyramidal and anticholinergic effects are common.
17.5 The nonphenothiazine, conventional antipsychotics have the same therapeutic applications
and side effects as the phenothiazines.
The non- phenothiazine antipsychotic medications have equal efficacy as the phenothiazines.
Although the incidence of sedation and anticholinergic side effects is less, extrapyramidal effects
may be common, particularly in elderly patients.
17.6 Atypical antipsychotics are often preferred because they address a broader range of
symptoms and produce less dramatic side effects.
The newer atypical antipsychotics are becoming drugs of choice for the treatment of
schizophrenia. They generally produce fewer side effects than the conventional medications. The
atypical agents produce frequent adverse effects which still require close monitoring.
17.6 Dopamine system stabilizers are the newest antipsychotic class. It is hoped that this new
class will have equal efficacy to other antipsychotic classes with fewer serious side effects.
Due to side effects caused by many antipsychotic drugs, a new class of medications known as
dopamine system stabilizers (DSSs) was developed. Aripiprazole (Ability) is the first of these
agents to receive approval for the treatment of schizophrenia and schizoaffective disorder.