ANTIPSYCHOTICS Katy and Zoë

Psychosis Mental disorder with a broad range of symptoms. Patients ‘lose touch with reality’ and present with: hallucinations (seeing, hearing, smelling, tasting or feeling things that are not there) delusions (false and unshakable beliefs) Serious defects in judgement (reasoning, evaluating objectively) Disturbed cognitive processing (thinking)

Schizophrenia ‘ Positive’ symptoms of psychosis accompanied by ‘negative’ symptoms of mood. Postitive -Psychosis symptoms (delusions, hallucinations, disorders of thinking etc.) Negative The 4 ‘A’s -Affective blunting (loss of emotional responses) -Ahedonia (loss of ability to enjoy anything) -Alogia (‘poverty of speech’) -Apathy

Antipsychotics Drug therapy works on the theory that psychosis is associated with increased dopamine release in the misolimbic pathway

First Generation (Classical) D 2 receptor antagonists Also have action at M 1, H 1 and α 1 receptors Low efficacy 30% patients non-responders Examples: Chlorpromazine Haloperidol

Second Generation (Atypical) Initially 5HT and dopamine antagonists Also have muscarinic, histamine and adrenergic receptor action. Better at dealing with negative symptoms than classical Reduced side effects Examples Clozapine Risperidone Olanzapine Quetiapine

Side Effects 5 main groups Extrapyramidal symptoms Cardiovascular (increased QT interval) Metabolic (weight gain, diabetes) Hormonal (hyperprolactinaemia) Other (sedation, headaches, anxiety)

Extrapyramidal symptoms Occurs in 75% of patients Result of altering the nigrostriatal pathway Dystonias (continuous spasms and muscle contractions) Parkinsonism (characteristic symptoms such as rigidity, bradykinesia and tremor) Akathisia (motor restlessness) Tardive Dyskinesia- involuntary choreiform movement (with prolonged use of classicals)

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