Quiz 20: Pharmacotherapy of Psychoses

Nursing

Haloperidol is first generation non-phenothiazine anti-psychotic drug with high potency and used to treat both acute and chronic disorders of psychoses. This drug is used off-label to treat Tourette's syndrome, autism, continuous hiccups, severe behavioral problems in children and for immediate sedation of severely agitated or excited patients. The main use of haloperidol (Haldol) in this situation is to treat agitation which is severe by immediate sedation. It depresses the brain parts like cerebral cortex, hypothalamus and limbic system which are involved in the aggression.

Atypical antipsychotics are the second generation antipsychotics used for the treatment of severe mental illness. When compared to the first generation antipsychotics they have lower incidence of adverse effects especially extra pyramidal symptoms as they bind less tightly to dopamine (D2) receptors. Examples of atypical antipsychotic drugs are risperidone, clozapine, iloperidone etc. When atypical antipsychotics are used to treat bipolar disorders, they are usually combined with other class of drugs like mood stabilizers for example valproic acid, lithium and antidepressant drugs like fluoxetine.

Schizophrenia is the psychotic disorder which is most common and it is characterized by the variety of symptoms that change over time. It begins to appear in early adulthood and its incidence in men is at peak of age between 15 to 24 years and in women between 25 to 34 years of age. These symptoms include abnormal thoughts and thought processes, communication problems, withdrawal from the people and environment, unable to perform the daily activities and a suicide risk. The most likely reasons George gives for discontinuing his medication are that he does not view his behavior as abnormal and he does not understood the need for drug therapy. He may also give the reasons that the medications are producing the undesirable adverse effects such as sexual dysfunction, severe muscle twitching etc.

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