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The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum

The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum

Psychopharmacology entails all the medication used in treating mental health illnesses. Medications can help play a significant role in most types of mental illnesses. Mental illness disorders require using a single medication, while others involve using combinations to achieve therapy. Effective medications for most mental illnesses involve a combination of drugs and psychotherapy. Other psychiatric may require multiple combinations to achieve an effective outcome. Finding the underlying cause of a mental disorder is the most significant in determining the kind and type of medication to alleviate the bizarre behaviors (Ceraso et al., 2020)The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum.   Underlying causes resulting in mental disorders include; pain, chronic psychiatric illness such as schizoaffective disorder, environmental triggers (excessive heat, noise, and overcrowding), substance intoxication, medical illness such as Alzheimer’s disease, and acute psychotic illness.

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Psychotic disorders are abnormalities in perception, beliefs, and thought processes. Psychotic disorders are prevalent in about 1% of the general population. The first onset of psychotic disorders affects individuals between the ages of fifteen and forty-five (Freudenreich et al., 2016). Men are termed to exhibit early symptoms than women. The most common type of psychotic disorders includes schizophrenia, schizoaffective disorder, and brief psychotic disorder substance-induced disorder. The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum

Antipsychotic medication

Antipsychotic medication is classified into the first and second generations. The first antipsychotic generation is known as a dopamine receptor antagonist, also known as typical antipsychotics. The second-generation antipsychotic medication is knowns as a serotonin – dopamine receptors antagonist and is also knowns as a typical antipsychotic medication. The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum

Typical antipsychotic medications

  • Haloperidol
  • Clozapine
  • Acetaphenazine
  • Phenothiazine’s

Atypical antipsychotics medications

  • Olanzapine
  • Risperidone
  • Clozapine
  • Lurasidone
  • Aripiprazole

Indications of antipsychotic medications

Schizophrenia ad schizoaffective disorders. First-generation antipsychotics are better for alleviating symptoms of schizophrenia,  such as hallucination, catatonia, and delusions; second-generation antipsychotics counteract negative symptoms of schizophrenia, such as withdrawal symptoms. The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum

Major depressive symptom with psychotic features. A combination of antipsychotics worth antidepressants serves as the best treatment modalities for clients with major depressive disorders expressing themselves with psychotic symptoms. Olanzapine and fluoxetine, according to the FDA, serve as vest therapy for patients with major depressive disorders associated with psychotic symptoms.

The first-generation antipsychotic medications are indicated for psychiatric patients with delusions and paranoia associated with personality disorders.

Typical antipsychotic drugs
Generic name Trade name The first dose (mg/day) Maximum daily dose (mg/day) Consideration
haloperidol Haldol 25- 100 Oral ranges from 100 to 2000   Intramuscular dosage is specifically 25 – 50 mg and never injected subcutaneously.
Fluphenazine Prolixin 2.5 -10 Oral dose not exceeding 40

Intramuscular- 10

 The concentrate should be diluted immediately and administered to ensure palatability and stability of the drug
loxapine Loxitane 20 Oral 250mg

Aerosol 10 mg

 The oral formulation requires rapid evaluation and mitigation strategies since it is prone to cause bronchospasm
Pimozide Orap 2- 4 10mg Not included in FDA, but is it used to eradicate delusional disorder?
Second-generation/ atypical antipsychotics
Aripiprazole Ability 10 -15 30 A maximum dosage of 30 mg should be exchanged for oral formulation. Tablet cannot  be crushed or split
Clozapine Clozaril 12.5- 25 900 Before administration, the prescribers should complete rapid examinations and strategies.
Olanzapine Zyprexa 5-10 20 A Short-acting IM formulation is used
Lurasidone latuda 40 160  The drug should be titrated slowly, not more than 4 mg/day.

 

Mechanism of action

Drug Mechanism of action
Haloperidol Alters the effect of dopamine of the dopamine receptors in the central nervous system.
Fluphenazine Blocks the activity of anticholinergic and beta-adrenergic receptors.
loxapine  Block the  dopamine and serotonin  at the postsynaptic receptors
pimozide Increases the brain turnover of dopamine, blocks calcium ions cha
Aripiprazole Block the dopamine D2 and serotonin receptors.
Clozapine Bids to dopamine receptors and has anticholinergic blocking activity.
olanzapine  

 

Pharmacokinetics of antipsychotic medications

  Absorption of antipsychotic medication solely depends on the characteristics of the drugs. Drugs taken orally differ between sexes. Gastric acidity is lower in women than men; thus, gastric emptying is slower. The solubility of antipsychotic drugs taken orally is affected by the composition of the bile acid. Metabolism of antipsychotics is achieved metabolized by the cytochrome P450 (Huang et al., 2018)The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum. Fluphenazine, perphenazine, haloperidol, risperidone, and thioridazine are actively metabolized by CYP2D6.

Antipsychotic medications are eliminated from the blood via hepatic, renal, and breast milk. Hepatic blood among women is lower than in men. Psychotic medications are determined by the individual body weight and the extent to of the drug binding to blood proteins.

Half-life

Drug half lie refers to the time taken for the amount of the drug’s active substance in a person’s body to reduce by half.

 

Importance of half-life

  • Half-life is important in determining excretion rates.
  • It also explains the concentration of specific drug formulations.
  • Enables in deciding modification of drug before administration depending on the  state of the individual
  • Half-life is vital in determining the safety of a specific drug before administration.
  • Half-life is used in determining which drugs to use when the failure of a certain body system, such as the kidney or liver.

The half-life of antipsychotic medications

Risperidone – extensive metabolization takes three hours

Lurasidone- eighteen hours

Haloperidol- twenty-one to twenty-four hours

Fluphenazine- fluphenazine hydrochloride takes 33 hours within the body system.

Clozapine- clozapine takes eight to twelve hours

Loxapine- three to four hours

Pimozide- pimozide takes the longest half-life, between twenty-nine and eleven hours.

Aripiprazole-   take seventy-nine hours.

Atypical antipsychotics are a newer class of antipsychotics that are less likely to cause side effects than typical antipsychotics. Atypical antipsychotics work by blocking serotonin and dopamine receptors in the brain. Serotonin is a neurotransmitter that is involved in the regulation of mood and emotions. Dopamine is a neurotransmitter that is involved in the development of psychosis (Alanen, 2018)The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum. Atypical antipsychotics help to reduce the symptoms of psychosis, such as delusions and hallucinations

Side effects

The main side effects of the medication used to treat schizophrenia are weight gain, drowsiness, and dry mouth. Other side effects may include constipation, blurred vision, and low blood pressure. Some more severe side effects of the medication used to treat schizophrenia are seizures, difficulty breathing, and an irregular heartbeat (Alanen, 2018).

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   Contraindications

Some of the contraindications of the medication used to treat schizophrenia include hypersensitivity to the medication, a history of seizures, and narrow-angle glaucoma. Other potential contraindications include pregnancy, breastfeeding, and children under 12 (Alanen, 2018).

Overdose considerations

When treating schizophrenia with medication, it is essential to be aware of the potential for overdose. Symptoms of an overdose may include drowsiness, confusion, slurred speech, and loss of coordination. If these symptoms occur, it is essential to seek medical help immediately (Alanen, 2018)The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum.

Diagnostics

Diagnostics and lab monitoring allow for proper and timely intervention if any changes or worsening in symptoms are observed. Additionally, regular lab monitoring can help identify any potential side effects of medication or other treatments (Alanen, 2018).

  Comorbidities considerations

The most common comorbidity among people with schizophrenia is depression. Other common comorbidities include anxiety, substance abuse, and eating disorders. Treatment for comorbidity must consider each disorder’s different symptoms and needs (Alanen, 2018)The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum.

Legal and ethical considerations

The legal considerations in treating schizophrenia mostly center on the patient’s right to refuse treatment. In many cases, people with schizophrenia cannot make decisions about their treatment, so involuntary treatment is often necessary. The ethical considerations are mostly centered on the potential for harm caused by the treatments for schizophrenia. There is a risk of severe side effects from many medications used to treat schizophrenia, so the decision to use them should be made carefully (Alanen, 2018)The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum.

Patient education considerations

Patient education considerations in treating schizophrenia include informing the patient about the nature of the disorder, the potential for relapse, and the importance of compliance with medication and other treatment regimens. It is also essential to educate the patient’s family and caregivers about the disorder and the need for support (Alanen, 2018). Other considerations include helping the patient to develop coping and problem-solving skills and to identify and avoid stressors that can trigger symptoms.

References

Alanen, Y. O. (2018). Treatment of schizophrenia and society. Schizophrenia, 237-257. https://doi.org/10.4324/9780429479731-7

Ceraso, A., Lin, J. J., Schneider-Thoma, J., Siafis, S., Tardy, M., Komossa, K., … & Leucht, S. (2020). Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews, (8).

Dufort, A., & Zipursky, R. B. (2019). Understanding and Managing Treatment Adherence in Schizophrenia. Clinical Schizophrenia & Related Psychoses.

Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier

https://content.waldenu.edu/content/dam/laureate/laureate-academics/wal/ms-nurs/nurs-6630/week-07/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf

https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum

Huang, A., Amos, T. B., Joshi, K., Wang, L., & Nash, A. (2018). Understanding healthcare burden and treatment patterns among young adults with schizophrenia. Journal of medical economics, 21(10), 1026-1035.

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, you will develop a study guide for an assigned psychotropic agent for treating patients with Schizophrenia Spectrum and Other Psychotic Disorders. You will share your study guide with your colleagues. In sum, these study guides will be a powerful tool in preparing for your course and PMHNP certification exam. The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum

To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.

https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Reflect on the psychopharmacologic treatments you might recommend for treatment of patients with Schizophrenia Spectrum and Other Psychotic Disorders.

Research your assigned psychotropic medication agent using the Walden Library. Then, develop an organizational scheme for the important information about the medication.
Review Learning Resource: Utah State University. (n.d.)The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum. Creating study guides. https://www.usu.edu/academic-support/test/creating_study_guides

The Assignment
Create a study guide for your assigned psychotropic medication agents. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the FDA-approved and Evidenced-Based, Clinical Practice Guidelines Research but also supported by at least three other scholarly resources.

https://www.usu.edu/academic-support/test/creating_study_guides

Areas of importance you should address, but are not limited to, are:

Title page
Description of the Psychopharmacological medication agent including brand and generic names and appropriate FDA indication uses
Any supporting, valid and reliable research for non-FDA uses
Drug classification
The medication mechanism of action
The medication pharmacokinetics
The medication pharmacodynamics
Mechanism of Action
Appropriate dosing, administration route, and any considerations for dosing alterations
Considerations of use and dosing in specific specialty populations to consider children, adolescents, elderly, pregnancy, suicidal behaviors, etc.
Definition of Half-life, why half-life is important, and the half-life for your assigned medication
Side effects/adverse reaction potentials
Contraindications for use including significant drug to drug interactions
Overdose Considerations
Diagnostics and labs monitoring
Comorbidities considerations
Legal and ethical considerations
Pertinent patient education considerations
Reference Page
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature. The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum

RESOURCES:

Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier.

https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf

https://content.waldenu.edu/content/dam/laureate/laureate-academics/wal/ms-nurs/nurs-6630/week-07/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf

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https://academic.oup.com/schizophreniabulletin/article/13/2/261/1919795?login=true

https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf

https://www.proquest.com/docview/223229782/fulltextPDF/C1856C2BB38C4C71PQ/2?accountid=14872 The Psychopharmacologic Treatments Of Patients With Schizophrenia Spectrum