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Hyperkinetic Movement Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Morales-Briceno Hugo, Victor S.C. Fung, Annu Aggarwal, Philip Thompson
Review need for antipsychotics—recurrence in 30% with rechallenge: If clinically indicated, restart in small dose, titrate slowly.Use atypical antipsychotics (but can still occur with atypical neuroleptics).
Actions of Dopamine on the Skin and the Skeleton
Published in Nira Ben-Jonathan, Dopamine, 2020
Atypical antipsychotics are widely used to treat many neuropsychological disorders that include schizophrenia, bipolar disorder, and autism. In addition to inducing obesity and causing adverse metabolic side effects, drugs with a strong antidopaminergic activity such as risperidone (RIS) also cause bone loss and increased fracture risk in both men and women. One potential mechanism of bone loss by RIS is hypogonadism due to hyperprolactinemia that results from D2R antagonism. However, many patients have normal PRL levels, suggesting a direct action of the drug on bone constituents. To examine for this possibility, mice were treated daily for 8 weeks with RIS or vehicle [56]. RIS caused a significant trabecular bone loss, which was due to increased bone turnover. All five DARs were expressed in primary mouse osteoclasts, and all but D3R were expressed in primary osteoblasts. Treatment of these cells with DA during differentiation caused the suppression of osteoblast mineralization and marker gene expression. The authors concluded that the reduced bone mineral density (BMD) and increased fracture risk caused by antidopaminergic drugs are due, in part, to their direct activation of DARs on bone cells.
Antipsychotic Drugs
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Harleen Kaur, Ramneek Kaur, Varsha Rani, Kanishka Sharma, Pawan Kumar Maurya
This chapter covers the use of common antipsychotic drugs (clozapine, reserpine, risperidone, olanzapine, haloperidol, quetiapine) in neuropsychiatric disorders. Authors also discussed various mechanism of action of aforementioned drugs. Despite the controversy that surrounds the use of atypical antipsychotic drugs in neuropsychiatric disorders, these medications are frequently being prescribed for the treatment of neuropsychiatric diseases. The final choice of atypical antipsychotic drugs should be guided by the nature and severity of the target symptom being treated, and the medication least likely to cause harm to the patient. Whenever possible, these atypical antipsychotic drug treatments should be combined with non-pharmacological treatments to limit the need and dose of antipsychotic drugs.
Risks and benefits of current and novel drugs to treat agitation in Alzheimer’s disease
Published in Expert Opinion on Drug Safety, 2022
Nathan Herrmann, Hui Jue Wang, Bing Xin Song, Kritleen K. Bawa, Krista L. Lanctôt
At the present time, there are no pharmacological interventions whose efficacy clearly and significantly exceeds potential safety concerns for treating agitation in AD. Clinicians would be warranted if they were frustrated by reading this summary and concluding that in spite of numerous trials, on hundreds of patients, with many new and repurposed drugs, little progress has been made in the past decade for treating this important and burdensome NPS. Unfortunately, atypical antipsychotics remain the most widely used and well-studied pharmacological interventions – despite very modest efficacy and significant potential safety concerns including an increased risk of mortality. Potentially new interventions including cannabinoids, escitalopram, and compounds containing dextromethorphan may eventually be proven to have better risk/benefit ratios, but more phase III type studies are still required, in particular to ensure safety. It is concerning that many of these new interventions already demonstrate a signal suggesting AEs that include sedation, dizziness and falls. It is unclear whether these represent AEs associated with the purported mechanism of action of these drugs, or whether these are nonspecific AEs reflective of the generally frail and susceptible medical status of most elderly patients with AD and agitation.
Symptoms and Treatment Needs of People with Dementia-Related Psychosis: A Mixed-Methods Study of the Patient Experience
Published in Clinical Gerontologist, 2022
Teresa Brandt, Theresa Frangiosa, Virginia Biggar, Angela Taylor, James Valentine, Bill Keller, Mark Price, Carla DeMuro, Victor Abler
The finding that many patients discontinued treatment due to side effects is consistent with the current literature regarding off-label use of atypical antipsychotics in elderly populations. Side effects of atypical antipsychotics include extrapyramidal symptoms (Ballard & Howard, 2006; Spindler, Galifianakis, Wilkinson, & Duda, 2013), orthostatic hypotension (Trigoboff et al., 2013), hematologic abnormalities (Ballard & Howard, 2006), metabolic disorders (Reynolds, 2011), and gastrointestinal, thrombo-embolic, and sedative effects (De Berardis et al., 2018). These agents are also associated with an increased risk for falls (and associated fractures) (Kuschel, Laflamme, & Moller, 2015), infection (Trigoboff et al., 2013), aspiration pneumonia (Hinkes, Quesada, Currier, & Gonzalez-Blanco, 1996; Saenger, Finch, & Francois, 2016; Trigoboff et al., 2013), and other serious complications in this vulnerable patient population (Ballard et al., 2009). The majority of these risks are serious and are communicated through warnings and precautions in FDA-approved labeling. Persons with Lewy body dementias may be particularly sensitive to adverse effects of antipsychotic use, with an increased risk of neuroleptic malignant syndrome noted in this population as well (Aarsland et al., 2005; McKeith, Fairbairn, Perry, Thompson, & Perry, 1992; Weintraub et al., 2016). Thus, there is a need for safe and effective therapies for persons with dementia-related psychosis.
An update on medication management of women with schizophrenia in pregnancy
Published in Expert Opinion on Pharmacotherapy, 2019
Carolyn Breadon, Jayashri Kulkarni
Women with schizophrenia seem to be more likely to deliver preterm babies, small for gestational age babies, and term babies of low birth weight [9,18,69,77,82]. Both typical and atypical antipsychotics may also increase the risk of premature birth; of these two, typical antipsychotics seem to confer a greater risk of prematurity [1,2,18,44]. Olanzapine [45] and aripiprazole [74] are the only atypical antipsychotics which have been specifically associated with high rates of prematurity. Polypharmacy may be associated with an increased risk of prematurity [30]. Medication dose has been reported in some studies to be related to the risk of prematurity [14]. Typical antipsychotic use in pregnancy is associated with small for gestational age babies and with low birth weight babies born at term [2,67]. Atypical antipsychotic use in pregnancy is not as consistently associated with small for gestational age babies [66]. Unlike most other atypical antipsychotics, aripiprazole has been associated with low birth weight [74].