Alright. In this video, we are going to talk about medications
that are used to treat psychotic disorders. Before we get into specific medications,
I do want to do a quick review of the positive and negative symptoms associated with schizophrenia.
So when I say positive symptoms, that means that there are
things present in the patient who has schizophrenia that should not be there.
So this includes delusions and hallucinations. So patients who suffer from schizophrenia will
have these things present. They shouldn't be there. Those are the positive symptoms.
And then, these patients will also have negative symptoms. So they will be
lacking in things that should be there. So a patient with schizophrenia, they may have
anergia, which is lack of energy, or anhedonia, which is lack of pleasure in doing things.
They should have those things present, but they are not there, and those are negative symptoms.
Alright. So let's now talk about typical or first-generation antipsychotics,
which includes medications such as chlorpromazine, haloperidol, and droperidol.
These medications are typically used to help control the positive symptoms associated
with schizophrenia and they work by altering the action of dopamine in the central nervous system.
So the way I remember at least one of these medications is that if you you have
hallucinations, then you may need haloperidol to help control those. So they both start with
hallucinations. It's got that H-A-L. Haloperidol also starts with H-A-L.
So in terms of side effects, there are many, many side effects with this class of medication
and if you look up any one of these drugs in a drug reference guide, you're going to see
a huge laundry list of side effects. So I'm going to go over some of the key ones here.
So with typical antipsychotics, extrapyramidal side effects are common. So this includes
dystonia, which are involuntary muscle contractions. It also includes Parkinson's-type
symptoms such as muscle rigidity and a shuffling gait. It can also include tardive dyskinesia,
which includes things like lip smacking and tongue rolling, as well as akathisia,
which includes restlessness and pacing. If your patient is having some of
these EPS symptoms, you can give them benztropine to help reduce those symptoms.
Another key side effect with typical antipsychotics is neuroleptic
malignant syndrome or NMS. NMS symptoms include fever,
blood pressure fluctuations, as well as dysrhythmias and muscle rigidity.
If your patient is having NMS symptoms, you can give them
dantrolene to help reduce those symptoms. Other side effects with typical antipsychotics
include agranulocytosis, which, if you recall from some of my previous videos,
that decreases the amount of white blood cells a patient has and increases the risk for infection.
In addition, anticholinergic side effects are common with this class,
which means it's very drying. So if you remember my previous mnemonic, "can't see,
can't pee, can't spit, and can't poop." And then, orthostatic hypotension,
seizures, and sedation are possible side effects with this class of medication.
Alright. Now, let's talk about second-generation or atypical antipsychotic medications.
Medications that fall within this class include risperidone, olanzapine, and clozapine.
So it's going to be really important to differentiate clonidine from clozapine.
So clonidine is used for hypertension, right? And clozapine is used for
schizophrenia like we're going to talk about here. Clozapine has that Z in the drug name,
and that will help you remember that it's used for schizophrenia with also has that Z.
If it doesn't have that Z, then it is not for schizophrenia.
Okay. So this class, these atypical or second-generation antipsychotics,
they are used to help control both the positive and negative symptoms of schizophrenia.
They act as a serotonin and dopamine antagonist in the body.
There are a lot of side effects with this class of medication as well, maybe not quite as many
as we saw with the typical antipsychotics, but there's a lot of really yucky ones here on this
list which makes it hard for patients to stay on a medication regimen when they have schizophrenia
because side effects can include diabetes, weight gain, increased cholesterol, as well as sedation,
orthostatic hypotension, anticholinergic effects, menorrhagia, decreased libido. And if we're taking
clozapine, then, that also carries a risk for agranulocytosis which, again, that means that the
patient's white blood cell count is going to come down, which places them at risk for infection.
So if your patient is on a second-generation or atypical antipsychotic medication,
you're definitely going to want to monitor their blood glucose during therapy because of that risk
for diabetes, and then you're definitely going to also want to monitor them for
infection because of that agranulocytosis risk. Okay. In my next video, we will be finishing
up our mental health medications. This includes ADHD medications, medications for alcohol abuse,
opioid dependence, as well as smoking cessation. Hang in there with me!