Psychotropic drugs for managing psychosis
In the realm of mental health treatment, the long-term use of antipsychotic medications plays a significant role in managing psychosis, a symptom associated with various mental health conditions such as schizophrenia and bipolar disorder. However, the use of these medications carries several important risks and effects that necessitate careful management.
One such long-term risk is the development of movement disorders, particularly tardive dyskinesia. This condition involves involuntary, often irreversible movements like lip puckering or limb writhing. While more common with first-generation antipsychotics, it can also occur with second-generation drugs.
Metabolic side effects, such as weight gain, are another concern. These can contribute to increased risks of diabetes and cardiovascular disease. These side effects are more common with some atypical antipsychotics.
Neuromotor side effects, like stiffness, tremors, and restlessness, can also impact a person's quality of life.
Endocrine effects, notably elevated prolactin levels from some antipsychotics, pose a risk, particularly in women, who may face an increased risk of breast cancer with prolonged use over one year or more. This risk appears specifically related to prolactin-raising antipsychotics, not prolactin-sparing ones like clozapine or quetiapine.
Despite these risks, long-acting injectable antipsychotics (LAIs) have been shown to reduce relapse rates and hospitalization after a first psychotic episode over a period of years, indicating a benefit in preventing recurrent psychosis when medication adherence is ensured.
Routine monitoring every 6 months is recommended for movement disorders such as tardive dyskinesia in patients on long-term antipsychotic treatment. Overall, careful choice of medication type, dose, and ongoing evaluation of side effects are essential to balance the benefits in controlling psychosis against these long-term risks.
It's crucial for anyone considering taking antipsychotic medication to discuss their individual risks and benefits with their doctor. The type of antipsychotic prescribed depends on a person's individual biological makeup and mental health condition.
Some common side effects of antipsychotic medicines include dystonias, Parkinsonism, akathisia, tardive dyskinesia, sialorrhea, sedation, elevated prolactin, sexual side effects, orthostatic hypotension, QT prolongation, neuroleptic malignant syndrome, neutropenia/agranulocytosis, impulse control disorders and behavioral addictions, myocarditis, weight gain and imbalance of blood lipids, anticholinergic effects, and increased risk of stroke and death among older adults with dementia.
Various antipsychotic drugs are available, including first-generation (older types) like Chlorpromazine, Fluphenazine, Haloperidol, Perphenazine, and Thioridazine, and second-generation (newer types) like Cariprazine, Brexpiprazole, and Asenapine.
Doctors do not typically prescribe risperidone or paliperidone as a first-line treatment during pregnancy, as these medications may present a slightly increased risk of fetal development abnormalities. Each individual antipsychotic medication has its own list of potential side effects, and the best medication for psychosis always depends on the individual and their unique condition.
The Food and Drug Administration (FDA) considers older adults with dementia to be at a higher risk of negative effects from antipsychotics, and the FDA requires that all antipsychotic medication labels warn people about the increased risk of stroke and death among this population group.
An ongoing study will assess the effects of continuing antipsychotic medication compared with reducing or discontinuing the medication on personal and social functioning, the severity of psychotic symptoms, and health-related quality of life.
In conclusion, while the long-term use of antipsychotics is supported by scientific evidence, it's essential to balance the benefits in controlling psychosis against the potential long-term risks. Regular monitoring and careful medication management are crucial for ensuring the best possible outcomes for individuals using these medications.
- In the field of health-and-wellness and mental health, beyond standard movement disorders like tardive dyskinesia, other long-term risks associated with antipsychotic medications include metabolic side effects, endocrine effects, and neuromotor side effects.
- For anyone considering taking antipsychotic medication, it's essential to engage in open dialogue with their doctor about the unique blend of benefits and risks that various medications present, such as the importance of balancing control of psychosis symptoms against potentially irreversible movement disorders, metabolic consequences, and increased risks of stroke and death.
