Transcript:

Antipsychotics are the primary medication for the treatment of psychosis. Psychosis can be a symptom of a mental disorder such as schizophrenia, bipolar mania, or severe depression.   

Antipsychotics work to relieve disorganized thoughts and behaviors, hallucinations, and delusions.  

In schizophrenia, these are known as positive symptoms. Additional symptoms of schizophrenia include negative symptoms such as anhedonia and cognitive symptoms such as impaired sensory perception, to name a few.  

In schizophrenia specifically, relapse and rehospitalization occur in nearly 70% of patients.  

Approximately 35% of these patients experience gradual worsening of daily functioning impairments after each relapse. Repeated relapses carry an increased risk of persistent psychotic symptoms.  

The use of antipsychotics is inversely linked to acute readmission risk in schizophrenia. Relapse rates have been reported at around 24% with antipsychotic use compared to 61% in placebo groups at 7 to 12 months.  

First-generation antipsychotics, also known as typical antipsychotics, work by inhibiting dopaminergic neurotransmission. They also have noradrenergic, cholinergic, and histaminergic inhibitory effects. 

Second-generation antipsychotics work by blocking D2 dopamine receptors as well as through 5-HT2A serotonin receptor antagonist action.  These are also known as atypical antipsychotics.  

First-generation antipsychotics are associated with some adverse side effects such as extrapyramidal symptoms, dry mouth, constipation, urinary retention, sedation, and cardiac effects.  

Second-generation antipsychotics have a different side effect profile than first-generation antipsychotics.  

Second-generation antipsychotics have been associated with weight gain, the development of metabolic syndrome, dizziness, anxiety, sedation, increased appetite, and somnolence.  

The FDA requires that all antipsychotic medication labels include a black-box warning stating that antipsychotics are associated with increased rates of stroke and death in older adults with dementia.  

Additionally, long-term use of antipsychotics can lead to weight gain, metabolic syndrome, diabetes, cardiovascular complications, and tardive dyskinesia.  

Another potential risk with long-term use of antipsychotics is that it can result in the development of drug tolerance, leading to dependence.  

Withdrawal symptoms can occur with the cessation of antipsychotic drugs, especially in infants, children, and adolescents.  

The symptoms of withdrawal will depend on the target receptor of the antipsychotic drug that has been stopped. 

Most antipsychotics should be discontinued very slowly under close medical observation. Abruptly stopping antipsychotic treatment can result in rebound psychosis that is sometimes more severe than before treatment.  

Overall, antipsychotics are an effective treatment option for managing symptoms of psychosis, such as those seen in schizophrenia.        

It is important to be aware of their potential side effects, especially with long-term use or abrupt discontinuation.