ANTIPSYCHOTICS
A person who is psychotic is out of touch with
same effect as a small amount of a "low-dose"
reality. He may "hear voices" or have strange
medication, such as haloperidol, why doesn't the
and untrue ideas (for example, thinking that
doctor just prescribe "low-dose" medications?
others can hear his thoughts, or are trying to
The main reason is the difference in their side
harm him, or that he is the President of the
effects (actions of the medication other than the
United States or some other famous person).*
one intended for the illness). These medications
He may get excited or angry for no apparent
vary in their side effects, and some people have
reason, or spend a lot of time off by himself, or
more trouble with certain side effects than
in bed, sleeping during the day and staying
awake at night. He may neglect his appearance,
desirable. For instance, the sedative effect of
not bathing or changing clothes, and may
some antipsychotic medications is useful for
become difficult to communicate with saying
patients who have trouble sleeping or who
things that make no sense, or barely talking at
all. These kinds of behaviors are symptoms of
Unlike some prescription drugs, which must be
psychotic illness, the principal form of which is
taken several times during the day, antipsychotic
schizophrenia. All of the symptoms may not be
medications can usually be taken just once a
present when someone is psychotic, but some
day. Thus, patients can reduce daytime side
of them always are. Antipsychotic medications,
effects by taking the medications once, before
as their name suggests, act against these
symptoms. These medications cannot "cure" the
available in forms that can be injected once or
illness, but they can take away many of the
twice a month, thus assuring that the medicine is
symptoms or make them milder. In some cases,
being taken reliably. Most side effects of
they can shorten the course of the illness as
antipsychotic medications are mild. Many
common ones disappear after the first few
weeks of treatment. These include drowsiness,
(neuroleptic) medications available. They all
rapid heartbeat, and dizziness when changing
work; the main differences are in the potency
that is, the dosage (amount) prescribed to
produce therapeutic effects and the side effects.
antipsychotic medications and may have to
Some people might think that the higher the
change their diet to control their weight. Other
dose of medication, the more serious the illness,
antipsychotic medications include decrease in
A doctor will consider several factors when
sexual ability or interest, problems with
prescribing an antipsychotic medication, besides
menstrual periods, sunburn, or skin rashes. If a
how "ill" someone is. These include the patient's
side effect is especially troublesome, it should
age, body weight, and type of medication. Past
be discussed with the doctor who may prescribe
history is important, too. If a person took a
a different medication, change the dosage level
particular medication before and it worked, the
doctor is likely to prescribe the same one again.
Some less potent drugs, like chlorpromazine
Movement difficulties may occur with the use of
(Thorazine), are prescribed in higher numbers of
antipsychotic medications, although most of
milligrams than others of high potency, like
them can be controlled with an anticholinergic
haloperidol (Haldol). If a person has to take a
medication. These movement problems include
large amount of a "high-dose" antipsychotic
muscle spasms of the neck, eye, back, or other
medication, such as chlorpromazine, to get the
muscles; restlessness and pacing; a general
and if it develops, whether the patient will
slowing-down of movement and speech; and a
recover. At present, there is no effective
shuffling walk. Some of these side effects may
treatment for tardive dyskinesia. The possible
look like psychotic or neurologic (Parkinson's
risks of long-term treatment with antipsychotic
disease) symptoms, but aren't. If they are
severe, or persist with continued treatment with
benefits in each individual case by patient,
an antipsychotic, it is important to notify the
doctor, who might either change the medication
or prescribe an additional one to control the side
unwanted effects when taken in combination
with other medications. Therefore, the doctor
Just as people vary in their responses to
should be told about all medicine being taken,
antipsychotic medications, they also vary in their
including over-the-counter preparations, and the
extent of the use of alcohol. Some antipsychotic
diminish in days, while others take weeks or
medications interfere with the action of
antihypertensive medications (taken for high
improvement is seen by the sixth week of
blood pressure), anticonvulsants (taken for
treatment, although this is not true in every case.
epilepsy), and medications used for Parkinson's
If someone does not seem to be improving, a
disease. Some antipsychotic medications add to
different type of medication may be tried.
the effects of alcohol and other central nervous system depressants, such as antihistamines,
Even if a person is feeling better or completely
antidepressants, barbiturates, some sleeping
well, he should not just stop taking the
medication. Continuing to see the doctor while tapering off medication is important. Some
people may need to take medication for an extended period of time, or even indefinitely. These people usually have chronic (long-term, continuous) schizophrenic disorders, or have a history of repeated schizophrenic episodes, and are likely to become ill again. Also, in some cases a person who has experienced one or two severe episodes may need medication indefinitely. In these cases, medication may be continued in as low a dosage as possible to maintain control of symptoms. This approach, called maintenance treatment, prevents relapse in many people and removes or reduces symptoms for others.
While maintenance treatment is helpful for many people, a drawback for some is the possibility of developing long-term side effects, particularly a condition called tardive dyskinesia. This condition is characterized by involuntary movements. These abnormal movements most often occur around the mouth, but are sometimes seen in other muscle areas such as the trunk, pelvis, or diaphragm. The disorder may range from mild to severe. For some people, it cannot be reversed, while others recover partially or completely. Tardive dyskinesia is seen most often after long-term treatment with antipsychotic medications. There is a higher incidence in women, with the risk rising with age. There is no way to determine whether someone will develop this condition,
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