Treatment of psychotic disorders (schizophrenia & other related disorders) 1- Psychopharmacology: - Antipsychotic medications(Neuroleptics) Prescribed for their efficacy in decreasing psychotic symptoms. Do not cure schizophrenia but used to manage the symptoms of the disease Psychiatric and Mental Health Nursing

Types of antipsychotics: 1. Older antipsychotic medications: dopamine antagonists, target positive signs of schizophrenia, as delusions, hallucinations & disturbed behavior. have no observable effect on the negative signs. 2. Newer or atypical antipsychotic medications are both (dopamine & serotonin antagonists) . - Diminish positive symptoms; also lessen the negative signs of lack of volition and motivation, social withdrawal, and blunt affect. Psychiatric and Mental Health Nursing

MAINTENANCE THERAPY: Antipsychotics injection available for maintenance therapy: Fluphenazine decanoate (modecate), haloperidol (Haldol), Zuclopenthixol (Clopixol) . Absorbed slowly over time. The effects: 2 – 4 weeks, Eliminating the need for daily oral antipsychotic medication. Psychiatric and Mental Health Nursing

MAINTENANCE THERAPY ….cont. It may take several weeks of oral therapy to reach a stable dosing level before transition to maintenance therapy. Not suitable for the management of acute episodes of psychosis. Very useful for clients requiring supervised medication compliance over an extended period. Psychiatric and Mental Health Nursing

*Typical ANTIPSYCHOTICS Chlorpromazine (Largctile) Fluphenazine (modicate) Thioridazine (Mellaril) Trifluoperazine (Trifluzine) Haloperidol (Haldol) Pimozide (Orap) *Atypical ANTIPSYCHOTICS Clozapine (liponex) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Aripiprazole (Abilify) Psychiatric and Mental Health Nursing

ANTIPSYCHOTIC DRUGS, DAILY DOSAGES, AND SIDE EFFECTS Key: + = Very low, ++ = Low, +++ = Moderate, ++++ = High, +++++ = Very high Generic (Trade) Name Daily Dosage* mg Sedation Hypo- tension EPS Anti- cholinergic Seizures Typical ANTIPSYCHOTICS   Chlorpromazine (Largctile) 200–1,600mg ++++ +++ ++ Fluphenazine (modicate) 2.5–20 mg + +++++ Thioridazine (Mellaril) 200–600 mg Trifluoperazine (Trifluzine) 6–50 mg Haloperidol (Haldol) 5–80mg +/0 Pimozide (Orap) 2–10 mg/day Atypical ANTIPSYCHOTICS Clozapine (liponex) 300–900 mg Risperidone (Risperdal) 2–8 mg Olanzapine (Zyprexa) 5–20 mg Quetiapine (Seroquel) 150–750mg Aripiprazole (Abilify) 10-30mg Psychiatric and Mental Health Nursing

Side Effects of antipsychotics: (1) Orthostatic Hypotension: Dizziness on standing or walking, managed byr ising from bed, moving slowly, and using assistive devices when necessary . (2) Anticholinergic Effects: Dry mouth and nose, blurred vision, constipation, urine retention. Managed symptomatically. Psychiatric and Mental Health Nursing

Side Effects of antipsychotics: ..cont. (3) Extra pyramidal Adverse Effects (EPS): a- Short-term side effects include: - Akathisia: “restless leg syndrome”. find it difficult to sit or sleep. activities are interrupted by the urge to move the limb or to change positions. - Dystonias, dyskinesias: grimacing, intermittent spasms, oculogyric crises, head-neck stiffness, twitches. - Parkinsonian effects: muscle stiffness, cog wheel rigidity, shuffling gait, stooped posture, drooling Psychiatric and Mental Health Nursing

Side Effects of antipsychotics: ..cont. b- Long-Term side effects (EPS): - Tardive dyskinesia: usually occurring after 6 months of treatment: abnormal, involuntary, irregular movements of the muscles of the head ( lip smacking, tongue protrusion, chewing, blinking, grimacing) and chore form- (rapid jerky) movements of limbs, and trunk. - Involuntary movements are embarrassing for clients causing them to become more socially isolated. -Tardive dyskinesia is worse irreversible, but decreasing/discontinuing medication can arrest progression. Psychiatric and Mental Health Nursing

Side Effects of antipsychotics: ..cont. Extra pyramidal Adverse Effects (EPS) can managed by using medications as: 1- Anticholinergics : Trihexyphenidyl (Artane), Benztropine (Cogentin), Biperiden (Akineton) 2- Antihistaminics: Promethazine (phenergan), Chlorophenramine (Ahiston) 3- Benzodiazpines: Diazepam (Valium), Lorazepam (loracare) Psychiatric and Mental Health Nursing

Side Effects of antipsychotics: ..cont. (4) Seizures: Rare side effect mainly occur with high doses of clozapine “liponex”. (5) Neuroleptic malignant syndrome (NMS): Serious and fatal condition. Characterized by muscle rigidity, high fever, increased muscle enzymes as (CPK), and leukocytosis . Psychiatric and Mental Health Nursing

Side Effects of antipsychotics: ..cont. (6) Agranulocytosis: “granulopenia”  (lowered white blood cell count) Clozapine (liponex) has potentially fatal side effect. Develops suddenly and characterized by fever, malaise, sore throat. Drug must stopped immediately. Clients taking “liponex” must have weekly white blood cell counts. Psychiatric and Mental Health Nursing

Treatment of psychotic disorders.. Cont. 2- Hospitalization: -Patients may receive treatment in hospital depends on severity of symptoms & risk of harm to self & others. -Community daily care and nocturnal care are recommended for less severe cases. Psychiatric and Mental Health Nursing

Treatment of psychotic disorders.. Cont. 3- Cognitive behavioral therapy CBT Albert Ellis theory (1913 – 2007) American psychologist, 1955 developed rational emotive behavior (REBT) Suitable in the later stages of recovery Individuals can positively influence their symptoms by changing behavior and thinking. Approach to therapy replace destructive ways of the past with constructive approaches for the future. Psychiatric and Mental Health Nursing

Treatment of psychotic disorders.. Cont. 4- Group Therapy: Social contact & relationships with other people. Groups focus on topics of concern such as medication management, community supports, social training skills. Each patient is talking about his experience with the disease and listens to the experiences of others Psychiatric and Mental Health Nursing

Treatment of psychotic disorders.. Cont. 5- Family Therapy: Diminish negative effects of schizophrenia and reduce the relapse rate. Make family members part of the treatment team. helps to cope with many difficulties and dealing with stigma of mental illness 6- Occupational therapy: Help psychotic patient to restore maximum level of functioning: through Vocational training , ADL instruction and social skills education. Psychiatric and Mental Health Nursing

Treatment of psychotic disorders.. Cont. 7- Electro Convulsive therapy (ECT): “Electroshock therapy”, “Shock treatment” Indicated for catatonic patients or limited response to antipsychotic drugs. Used as a last line of intervention for Other disorders e.g. major depressive disorder and mania. Need informed consent Psychiatric and Mental Health Nursing