The use of antipsychotic medications entails a difficult trade-off between the benefit of alleviating psychotic symptoms and the risk of troubling, sometimes life-shortening adverse effects. There is more variability among specific antipsychotic medications than there is between the first- and second-generation antipsychotic classes. The newer second-generation antipsychotics, especially clozapine and olanzapine, generally tend to cause more problems relating to metabolic syndrome, such as obesity and type 2 diabetes mellitus. Also, as a class, the older first-generation antipsychotics are more likely to be associated with movement disorders, but this is primarily true of medications that bind tightly to dopaminergic neuroreceptors, such as haloperidol, and less true of medications that bind weakly, such as chlorpromazine. Anticholinergic effects are especially prominent with weaker-binding first-generation antipsychotics, as well as with the second-generation antipsychotic clozapine. All antipsychotic medications are associated with an increased likelihood of sedation, sexual dysfunction, postural hypotension, cardiac arrhythmia, and sudden cardiac death. Primary care physicians should understand the individual adverse effect profiles of these medications. They should be vigilant for the occurrence of adverse effects, be willing to adjust or change medications as needed (or work with psychiatric colleagues to do so), and be prepared to treat any resulting medical sequelae.
older first-generation antipsychotics are more likely to be associated with movement disorders, but this is primarily true of medications that bind tightly to dopaminergic neuroreceptors,
less true of medications that bind weakly
All antipsychotic medications are associated with an increased likelihood of sedation, sexual dysfunction, postural hypotension, cardiac arrhythmia, and sudden cardiac death.
hyperprolactinemia
Includes decrease in muscle mass
Antipsychotic medications should be used with caution in older adults because of the risk of increased mortality from sudden cardiac death and cerebrovascular accidents.
terms “low-potency” and “high-potency,” not to indicate their clinical effectiveness, but rather to indicate their potency in binding to this dopamine D2 neuroreceptor
new anti-psychotics were considered atypical because they targeted neuroreceptors other than only dopamine
Risperidone (Risperdal) 1994 3 to 6 mg
Aripiprazole (Abilify) 2002 10 to 30 mg
likely that the adverse effect profile of Invega will be similar to that of risperidone
McK ER doctor thought Invega was more problematic than Latuda.
Many patients become tolerant to the sedative effect over time
Somnolence can be alleviated by lowering the dosage, changing to a single bedtime dose, or switching to a less sedating medication.
constipation, urinary retention
tardive dyskinesia
(inc. grimacing)
acute dystonia
involuntary maintained contraction of agonist and antagonist muscles yielding abnormal posturing, twisting and repetitive movements, or tremulous and can be initiated or worsened by attempted movement. Dystonia is a dynamic disorder that changes in severity based on the activity and posture.
rigidity in the arms and shoulders,
