conventional antipsychotic drug

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M1. 1. H1. conventional antipsychotic drug. D2. Stahl S M, Essential Psychopharmacology (2000). 11-7. Stahl S M, Essential Psychopharmacology (2000). 11-2. pure D2 blocker. Mesocortical pathway. Increase in negative symptoms. Stahl S M, Essential Psychopharmacology (2000). 11-3. - PowerPoint PPT Presentation

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  • pure D2 blocker

  • Motor and mental features of neuroleptic-induced extrapyramidal side effectsParkinsonismTremor (resting), rigidity, bradykinesia, masklike facies

    AkathisiaRestlessness, pacing, fidgeting, shifting from jitteriness, anxiety, irritability, anger, difficulty concentrating

    DystoniaMuscle contractions, tongue protrusion, torticollis, opisthotonos, fear, distress, paranoia

    Tardive Buccolingual-masticatory movements of irregular dyskinesia (nonrhythmic) nature; choreiform or athetoid (writhing) movements of fingers, extremities, trunk

    Adapted from Ayd 1995; Casey 1995

  • D2 receptorprolactinD2 antagonistpituitary lactotroph

  • Typical antipsychotic drugs: potencies and side effect profilesDrug Approximate Sedative Hypotensive Anticholinergic Extrapyramidal dose (mg) effect effect effect effectPhenothiazines Chlorpromazine (Thorazine) 100 H H M LPiperidines Thioridazine (Mellaril) 95 H H H LPiperazines Fluphenazine (Prolixin) 2 M L L H Perphenazine (Trilafon) 8 L L L H Trifluoperazine (Stelazine) 5 M L L HThioxanthene Thiothixene (Navane) 5 L L L HButyrophenones Haloperidol (Haldol) 2 L L L H

  • 5HT-DA Interactions

  • serotonin neurondopamine neuronSubstantia nigraRaphedopamine5HT2A receptorserotonin5HT2A receptor

  • mesocortical pathwayprimary dopamine deficiencysecondary dopamine deficiencydopamine releaseserotoninSDA

  • 5HT2A receptorNigrostriatal pathway

  • Side effects of selected atypical agents

  • POSITIVE SYMPTOM PHARMACY3rd line treatment2nd line treatmentnoncompliant (depot)1st line treatmentin case of emergencypolypharmacycombosD2clozapineD2SDAD2BZ

  • Hierarchy of Treatment Goals in Medical Psychotherapy of SchizophreniaAcute PhaseMedical/neuropsychiatric assessmentRapid symptom reductionReduce impact of episode on friends, family, housing, activitiesConvalescent PhaseGain trust/alliance with family/caregiversAssess and mobilize social supportsEnsure human service needs are met (food, clothing, housing)Ensure safety and predictability of environmentAdaptive PlateauEstablish therapeutic alliance/supportive treatment routineAchieve effective maintenance medication regimeStable plateauPsychoeducation: Promote illness self-management strategies, awareness of relationship between stress and symptomsRehabilitation: Teach adaptive competencies

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