An antipsychotic is a medication that is used to help treat
psychotic symptoms. Psychotic symptoms involve distortions of reality and can
include symptoms such as hallucinations, extreme paranoia or fear and
disorganized thinking. These symptoms can occur in a range of mental illnesses
that include schizophrenia, depression and mania. The antipsychotic drugs (antipsychotics) are used in a range of
conditions. They are the mainstay of the treatment of schizophrenia.
However,
they are also the mainstay of the management of delusional disorder, psychosis
which occurs in dementia, they have a place in the management of delirium, and
they must be added to antidepressants for the successful management of
psychotic depression. The antipsychotics have a central place in the management
of acute mania (even in the absence of delusions and hallucinations).
Olanzapine and aripiprazole have recently gained acceptance as mood stabilizers
(prophylactic agents in mood disorders). Quetiapine has recently been approved
by the FDA (USA) as a treatment for bipolar depression (Dando & Keating,
2006). In rare cases antipsychotics are used in the management of insomnia and
anxiety (Carson et al, 2004).
Antipsychotic agents have been widely used since the 1950s, when
they revolutionized the care of patients with severe psychiatric disorders.
More than 20 of these agents have been introduced in the United States since
that decade. With a generally good benefit-to-risk ratio, antipsychotic drugs
have substantially improved functioning and quality of life for a number of
patients with psychotic disorders. Antipsychotics that were in use through the
1980s are generally referred to as conventional antipsychotics, and newer
agents developed in the 1990s are referred to as atypical antipsychotics.
Atypical antipsychotics differ from conventional antipsychotics in their
decreased tendency to cause reversible drug-induced movement disorders/motor
side effects such as dystonia, drug-induced Parkinsonism, and akathisia and
potentially persistent drug-induced movement disorders/motor side effects such
as tardive dyskinesia, while simultaneously reducing psychotic symptoms.
Although all atypical antipsychotics have antipsychotic action with fewer motor
side effects than conventional antipsychotics, no antipsychotic agent
completely removes a patient’s risk of developing a movement disorder or less
harmful adverse events. Elderly patients are especially vulnerable to side
effects of any medication, and antipsychotic agents are no exception.
A number of adverse
effects have been observed, including extrapyramidal
effects on motor control –
including akathisia
(constant discomfort causing restlessness), tremor, and abnormal muscle contractions, an
involuntary movement disorder known as tardive dyskinesia,
and elevations in prolactin
(resulting in breast enlargement in
men, breast milk discharge, or
sexual dysfunction).
Some atypical antipsychotics have been associated with metabolic syndrome
and, in the case of clozapine,
lowered white blood cell
counts.
In some instances a return of psychosis can occur, requiring
increasing the dosage, due to cells producing more neurochemicals to compensate
for the drugs (tardive psychosis),
and there is a potential for permanent chemical dependence
leading to psychosis worse than before treatment began, if the drug dosage is
ever lowered or stopped (tardive dysphrenia). Most
side-effects disappear rapidly once the medication is discontinued or reduced,
but others, particularly tardive dyskinesia,
may be irreversible.
Temporary withdrawal symptoms including insomnia, agitation,
psychosis, and motor disorders may occur during dosage reduction of
antipsychotics, and can be mistaken for a return of the underlying condition. Antipsychotic medications can reduce or relieve symptoms of
psychosis, such as delusions (false beliefs) and hallucinations (seeing or
hearing something that is not there). Formerly known as major tranquilizers and
neuroleptics, antipsychotic medications are the main class of drugs used to
treat people with schizophrenia. They are also used to treat people with
psychosis that occurs in bipolar disorder, depression and Alzheimer disease.
Other uses of antipsychotics include stabilizing moods in bipolar disorder,
reducing anxiety in anxiety disorders and reducing tics in Tourette’s syndrome.
Antipsychotic medications can help to calm and clear confusion in
a person with acute psychosis within hours or days, but can take up to four or
six weeks to reach their full effect. These medications can help to control
symptoms, but they do not cure the underlying condition. When taken over a
longer term, antipsychotics can help to prevent further episodes of psychosis.
While antipsychotic medications can help some people with
psychosis and mood disorders, at the same time these drugs can have serious
side-effects. The aim of medication treatment is to reduce and control symptoms
while keeping side-effects at a minimum.
Combining antipsychotic medication with other therapy and support
can help people to manage symptoms and improve quality of life. Family therapy,
peer support, school and job counseling and housing and employment supports
can all be helpful. Some therapists now offer cognitive-behavioural therapy to
help people cope with voices.