Antipsychotics – introduction, classification, side effects…


Neuroleptics, another name for antipsychotics, are a family of drugs used to treat psychotic symptoms such delusions, hallucinations, and disordered thinking. They are essential in the treatment of mental illnesses including as bipolar disorder, schizophrenia, and some forms of depression. Typical (first-generation) and atypical (second-generation) antipsychotics are the two primary classifications. Atypical antipsychotics impact both dopamine and serotonin receptors, although typical antipsychotics mostly inhibit dopamine receptors. Individual circumstances will determine which drug is best, and treatment programs may combine medication, psychotherapy, and other services. In order to evaluate efficacy and control any adverse effects, regular monitoring by medical specialists is necessary.

Antipsychotics classification:

Antipsychotics are classified into two main groups: typical (first-generation) antipsychotics and atypical (second-generation) antipsychotics. Each group has distinct characteristics, mechanisms of action, and potential side effects.

1.Typical Antipsychotics (First-Generation):

Typical antipsychotics, also known as first-generation antipsychotics, were among the first medications developed to treat psychotic disorders. They primarily exert their effects by blocking dopamine receptors in the brain. Here are some examples of typical antipsychotics:

  1. Chlorpromazine (Thorazine): One of the earliest antipsychotic medications, chlorpromazine is used to treat various psychotic disorders. It has a calming effect and is also known for its antiemetic properties.

  2. Haloperidol (Haldol): Often used to treat schizophrenia and other psychotic disorders, haloperidol is known for its potency. It has a high affinity for dopamine receptors and is used in both oral and injectable forms.

  3. Fluphenazine (Prolixin): This medication is used to treat symptoms of schizophrenia and other psychotic disorders. It is available in both oral and injectable formulations.

  4. Perphenazine: Another first-generation antipsychotic, perphenazine is used in the treatment of schizophrenia and related conditions. It has a lower risk of sedation compared to some other typical antipsychotics.

  5. Thioridazine: Although less commonly prescribed today due to its association with potential cardiac side effects, thioridazine was historically used to treat schizophrenia and other psychotic disorders.

It’s important to note that while typical antipsychotics can be effective in managing psychotic symptoms, they are also associated with a higher risk of extrapyramidal symptoms (EPS) and tardive dyskinesia. As a result, second-generation antipsychotics (atypical antipsychotics) have become more commonly prescribed due to their potentially lower risk of certain side effects. The choice between typical and atypical antipsychotics depends on individual factors and the specific needs of the patient.

2.Atypical Antipsychotics (Second-Generation):

Atypical antipsychotics, also known as second-generation antipsychotics, are a class of medications used to treat various mental health conditions, particularly psychotic disorders such as schizophrenia and bipolar disorder. These medications differ from typical (first-generation) antipsychotics in their pharmacological profile and mechanism of action. Here are some key characteristics of atypical antipsychotics:

  1. Broader Receptor Profile:

    • Atypical antipsychotics affect both dopamine and serotonin receptors in the brain. This broader receptor profile is thought to contribute to their efficacy and different side effect profile compared to typical antipsychotics.
  2. Examples of Atypical Antipsychotics:

    • Common atypical antipsychotics include:
      • Clozapine
      • Risperidone
      • Olanzapine
      • Quetiapine
      • Aripiprazole
      • Ziprasidone
      • Lurasidone
      • Paliperidone
  3. Reduced Risk of Extrapyramidal Symptoms (EPS):

    • Atypical antipsychotics are generally associated with a lower risk of extrapyramidal symptoms such as tremors, rigidity, and tardive dyskinesia compared to typical antipsychotics.
  4. Lower Risk of Neuroleptic Malignant Syndrome (NMS):

    • Neuroleptic Malignant Syndrome, a rare but serious reaction to antipsychotic medication, is less commonly associated with atypical antipsychotics.
  5. Improved Tolerability:

    • Atypical antipsychotics are often considered more tolerable in terms of side effects, leading to better adherence to treatment plans.
  6. Treatment of Mood Disorders:

    • Some atypical antipsychotics, such as quetiapine and aripiprazole, are also used in the treatment of mood disorders like bipolar disorder and major depressive disorder.
  7. Metabolic Side Effects:

    • Atypical antipsychotics are associated with metabolic side effects, including weight gain, dyslipidemia, and an increased risk of diabetes. Monitoring of metabolic parameters is important during treatment.
  8. Individual Differences:

    • Response to atypical antipsychotics can vary among individuals, and healthcare professionals may need to tailor the choice of medication based on the patient’s specific symptoms, medical history, and tolerance to side effects.

It’s important for individuals prescribed atypical antipsychotics to have regular check-ups with their healthcare providers to monitor the effectiveness of the treatment and manage any potential side effects. The decision to use a specific atypical antipsychotic and the dosage will be based on a thorough assessment of the individual’s unique needs and circumstances.

                  These classifications help healthcare professionals determine the appropriate antipsychotic medication based on the individual’s symptoms, medical history, and potential risk of side effects. Treatment plans may involve a careful selection of medication, and adjustments may be made based on the patient’s response and tolerability.

Antipsychotics side effects:

Antipsychotic medications can have a range of side effects, and their severity and prevalence can vary among individuals. It’s important to note that the benefits of these medications often outweigh the potential side effects, and healthcare professionals carefully weigh the risks and benefits when prescribing them. Here are some common side effects associated with antipsychotic medications:

  1. Extrapyramidal Symptoms (EPS):

    • These can include tremors, rigidity, bradykinesia (slowness of movement), and tardive dyskinesia (involuntary, repetitive movements).
  2. Metabolic Effects:

    • Weight gain is a common side effect, particularly with atypical antipsychotics.
    • Changes in blood glucose levels and lipid profiles may occur, increasing the risk of diabetes and cardiovascular issues.
  3. Sedation and Drowsiness:

    • Many antipsychotics can cause drowsiness, sedation, and a feeling of fatigue.
  4. Orthostatic Hypotension:

    • A sudden drop in blood pressure upon standing, leading to dizziness or fainting.
  5. Anticholinergic Effects:

    • Dry mouth, blurred vision, constipation, and urinary retention are examples of anticholinergic side effects.
  6. Hyperprolactinemia:

    • Elevated levels of the hormone prolactin, which can lead to menstrual irregularities, breast enlargement, and lactation.
  7. Neuroleptic Malignant Syndrome (NMS):

    • A rare but potentially life-threatening reaction characterized by hyperthermia, muscle rigidity, altered mental status, and autonomic dysfunction.
  8. QT Prolongation:

    • Some antipsychotics may affect the heart’s electrical conduction, potentially leading to an irregular heartbeat (arrhythmia).
  9. Increased Risk of Falls:

    • Especially in the elderly, antipsychotics may increase the risk of falls and fractures.
  10. Sexual Side Effects:

    • Changes in libido, sexual dysfunction, and issues with arousal or orgasm.

It’s crucial for individuals taking antipsychotics to communicate openly with their healthcare providers about any side effects or concerns. Regular monitoring, dosage adjustments, or changes in medication may be necessary to manage side effects effectively while maintaining the therapeutic benefits of the treatment. Patients should not discontinue or adjust their medication without consulting their healthcare professional.

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