Antipsychotics


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Antipsychotics, (also known as neuroleptics, tranquilizers, and anxiolytics) are medications primarily used for the treatment of mania resulting from bipolar disorder or schizophrenia (a serious brain and mind disorder) that basically affects how an individual thinks, behaves, and feels. They are also used in the treatment of severe anxiety and depression. While there is no concrete data on its global prevalence, schizophrenia is estimated to affect approximately 1% of the total population.

There are currently more than 15 different types of antipsychotics that are primarily classified under two categories: atypical (second-generation) and typical (first-generation) antipsychotics. These medicines, though very effective, are known to cause side effects. It is therefore recommended that patients undergo regular checkups to track their effectiveness and lower the risks of adverse effects. They are available in different forms, such as long-acting depot injections, liquids, capsules and tablets.

While the first-generation (typical) antipsychotics have been in used from 1950s, they are still prescribed today. They have constantly been improved specially to minimize the resulting side effects leading to the second-generation antipsychotics that were developed from 1970s to date.

Mechanism of Action

The prescription of antipsychotics is in most cases informed by the psychotic disorders' resultant symptoms, such as abnormal behaviors, delusions, hallucinations, and effects of tranquilizers in aggressive patients. Today, atypical antipsychotics are especially preferred over the older ones primarily due to fewer side effects and favorable compliance with patients. Some common brands include Olanzapine, Aripiprazole, Clozapine, Risperidone, and Amuslpride. They are effective in the treatment of conditions such as chronic psychoses like schizophrenia, acute mania, organic psychoses, and serious behavioral disorders in children.

The precise mechanisms of these medicines are not clear. It is however believed that they work by blocking some of the brain's chemical receptors responsible for the disorders, leading to relief in patients. Risperidone, for example, is believed to block dopamine and serotonin by creating paliperidone. Other receptors blocked by different antipsychotics include dopaminergic, muscarinic, histaminic and serotonergic, restoring chemical imbalance in the patient's brain.

Prescription

Antipsychotics are strictly prescription-only drugs. It is therefore upon the doctor to evaluate the patient before prescribing suitable treatment. Some tests may be carried out to determine whether you have conditions like diabetes, the volumes of lipid in the blood, the functioning of body organs like the liver and kidney, and your blood cells.

In most cases, the general practitioner may have to consult a specialist, especially a psychiatrist before prescribing these drugs. For years, they have been used to calm the elderly suffering from dementia. This is not recommended because they are believed to increase the risks of early death due to stroke. The only alternative that is still recommended for use by this group of patients, but only for short durations and serious symptoms is risperidone.

The specialists also evaluate the severity of the symptoms and any other underlying health conditions. The effectiveness of these medications vary from one type to another, especially based on their sedating effects. How patients respond to medicine also varies from person to person. It is therefore possible for a specialist to try more than one type over type to establish which treatment works well with your body. In the beginning, a smaller dose is prescribed and gradually increased over time depending on how the body responds to the treatment.

Oral vs Injectable Antipsychotics

The most common method of administering antipsychotics is oral. However, this method suffers from one major shortcoming: it takes long for the drugs to stabilize the patients, as well as there is a higher risk of noncompliance. Compliance to treatment is very important, and for fast and long durations of relief, injectable antipsychotics are preferred. This is best realized with behavioral therapies to avoid relapses while managing the symptoms of the conditions.

How Effective Are Antipsychotics?

As mentioned earlier, the performance of these medications varies from one patient to another and also the type of medicine used. Generally, 80% of patients who have used this treatment have recorded positive improvements. However, it is worth noting that, in as much as the drugs may lower the severity of the symptoms, they cannot completely heal patients from these psychotic conditions. Some patients may have to undergo treatment for longer periods even after recording impressive improvements to avoid relapses. Patients feel the effects of the drugs in between 2 and 4 weeks.

Common Side Effects

It is important to emphasize the fact that, in as much as a lot of research has gone into lowering the prevalence of common side effects of antipsychotics, patients may still have to deal with some.

  • Sedation/drowsiness;
  • Blurred vision, dry mouth, constipation and flushing;
  • Gaining weight;
  • Possible movement disorders like Parkinsonism, akathisia, dystonia, among others;
  • Insomnia;
  • Anxiety.

Some medicines may results in high volumes of glucose in the brain and weight gain that may even cause type 2 diabetes. Some drugs are also believed to cause variant dose dependency. The exact mechanisms of some of the medicines such as remain unknown but others have a very complex pharmacology that makes them effective in the management of schizophrenia. Some of these symptoms, such as movement disorders are only common with the first-generation antipsychotics. The only way to avoid them is by changing the medication.

Discontinuation

In case you would like to discontinue treatment, it is highly recommended that you consult your doctor. You will be guided on the best timing for discontinuation. Generally, gradual reduction of the dosage over weeks may be recommended instead of abrupt discontinuation.