Prescribing for a first episode of schizophrenia-like psychosis
Kathy J Aitchison, Karena Meehan, Robin M Murray in First Episode Psychosis, 2021
Consolidation refers to the continuation of treatment when the acute symptoms are resolving, in order to consolidate the response. Many clinicians would advise continuing antipsychotic therapy for approximately a year (minimum of 6 months) after a first psychotic episode. However, in McGorry's first-episode work reported to date, less than half of the sample were still receiving neuroleptics at 6 months.8 One of the reasons for this is that only 30.5% of the sample initially met the diagnostic criteria for schizophrenia; for those with a diagnosis of schizophrenia or schizo-phreniform disorder, the aim is 6 to 12 months of antipsychotic treatment. This may be further extended if positive symptoms persist, and beyond that into a period of remission to allow for consolidation. With affective psychoses a similar duration of therapy was aimed for, but 6 to 9 months was probably more common. There are therefore no absolute guidelines as to the length of remission into which treatment should continue for consolidation, but a minimum of 6 months would seem reasonable.
Introduction to dementia
Joanne Brooke in Dementia in Prison, 2020
Antipsychotics are medications that are prescribed to treat hallucinations and delusions, as well as schizophrenia. Antipsychotic medications may also be helpful for anxiety and agitation and problems with mood, thinking and socialising. Most antipsychotic medications are tablets, capsules or liquid (Barnes et al., 2012). Risperidone is the only licensed medication for the short-term treatment of aggression in Alzheimer’s disease, and only if aggression poses a risk or the person has not responded to non-drug approaches. Drug trials have shown that risperidone has a small but significant beneficial effect on aggression and, to a lesser extent, psychosis for people with Alzheimer’s disease. These effects are seen when the drug is taken for a period of 6–12 weeks; after this time the medication can be no longer effective (Katz et al., 1999). Many people with LBD who are treated with antipsychotic medications have very severe reactions, including their symptoms becoming exacerbated, and adversely sedated and increased symptoms of parkinsonism. In rare cases, antipsychotic medications may cause a condition called ‘neuroleptic malignant syndrome’ which causes severe fever, muscle rigidity, kidney failure and even death (McKeith et al., 1995).
The Distortion of Consciousness
Max R. Bennett in The Idea of Consciousness, 2020
The modified dopamine hypothesis, which allows for the importance of serotonin in schizophrenia, has been applied to those areas of the brain that receive a rich dopaminergic projection from the ventral tegmentum. Whether this will provide an explanation at the molecular level for the distortions of consciousness that arise in the schizophrenic brain is not clear at this time. Indeed, it is possible that problems with transmission in the thalamus or even in the basal ganglia are the principal causes of this dreadful malady. One further problem with the dopamine hypothesis is that the antipsychotics take some weeks to take an effect. This implies that a simple binding of the drugs to dopamine or serotonin receptors, which should be completed in a few hours following administration, is not the determinant of the time course of alleviation of the schizophrenic condition after taking the drugs. The time scale is more like that to be expected for the growth of new nerve terminals or at least for the synthesis of a protein. Given the difficulty of the task, it is reassuring that the technical means to unravel this problem, such as imaging the brain and molecular biology, are now at hand.
Switching to long-acting injectable antipsychotics: pharmacological considerations and practical approaches
Published in Expert Opinion on Pharmacotherapy, 2023
Mikkel Højlund, Christoph U. Correll
Knowledge about time to peak, half-life and time to steady state of antipsychotic plasma levels will determine the optimal approach to switching. If the active antipsychotic substance is released immediately and in sufficient amounts, oral supplementation is not necessary, and switching can focus on avoiding rebound effects or overlapping pharmacodynamic effects of antipsychotics with similar receptor profiles. If the active substance is not released immediately or in amounts too low to achieve clinically effective plasma levels within days, oral supplementation is necessary. Due to long plasma half-lives of LAIs after multiple injections, switching from one LAI to another can often be done by replacing the next scheduled injection with the new LAI and without the need for oral supplementation. Preexisting plasma levels of the pre-switch LAI will provide antipsychotic coverage and decrease only slowly until sufficient amounts of the post-switch LAI have been released from the injection site.
Current and emerging treatment options for Angelman syndrome
Published in Expert Review of Neurotherapeutics, 2023
Christopher J. Keary, Christopher J. McDougle
For more severe cases of aggression and SIB in patients with AS that do not improve with the above treatment approaches, additional medications may be considered. Two antipsychotic medications, risperidone and aripiprazole, have an FDA indication for the treatment of ‘irritability associated with ASD’ in children and adolescents which may include aggression and SIB. No studies or case reports have examined their use in patients with AS. Moreover, antecedents for aggression in AS may be more likely to include attention seeking behaviors which may represent a different clinical issue than ‘irritability’ as it presents in ASD. Potential side effects of atypical antipsychotics such as increased appetite, weight gain, constipation, fatigue, metabolic syndrome, and tardive dyskinesia must be considered. Anti-epileptic drugs such as topiramate or gabapentin are commonly considered in clinical practice for aggression in AS. The anti-epileptic drugs valproic acid, carbamazepine, and oxcarbazepine should in most cases be avoided for the treatment of aggression and SIB in AS due to the risk for worsening seizures or motor function [31].
Repurposing antipsychotic drugs for cancer treatment: current evidence and future perspectives
Published in Expert Review of Anticancer Therapy, 2022
Georgios D. Lianos, George A. Alexiou, Stefano Rausei, Vasiliki Galani, Michail Mitsis, Athanasios P. Kyritsis
Antipsychotics are a widely used medication used to manage a plethora of psychotic disorders. We describe two generations of antipsychotics. In detail, first-generation antipsychotics, developed in the 1950s’, are dopamine receptor antagonists, also known as typical antipsychotics, while the novel, second-generation, antipsychotics also function at other receptors, including antagonizing the serotonin 2A receptors (5-HT2AR). It is reported that the first-generation drugs work by inhibiting dopaminergic neurotransmission, while second-generation drugs work by blocking D2 dopamine receptors as well as serotonin receptor antagonist action [5]. First-generation antipsychotics are associated with more extrapyramidal motor side-effects and prolactin elevation and are of lower cost, while second generation may cause weight gain and sedation.
Related Knowledge Centers
- Delusion
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