The Side Effects Of Antipsychotics
Antipsychotics can be divided into two groups: first-generation and second-generation. The first-generation antipsychotics were the first to be used in psychiatry, followed by the second-generation antipsychotics. Both classes have distinct medical side effects that are important to mention. Patients and their families always need to be properly educated on the the side effects of medications; medical problems can unexpectedly arise and cause confusion and discomfort if not previously warned about.
The first-generation antipsychotics:
- Haloperidol
- Loxapine
- Thioridazine
- Thiothixene
- Molindone
- Fluphenazine
- Mesoridazine
- Trifluoperazine
- Perphenazine
- Chlorpromazine (the first antipsychotic used)
The unique medical side effects from first-generation antipsychotics are called “extrapyramidal symptoms.” These include:
- Dystonia (continuous spasms and muscle contractions)
- Akathisia (motor restlessness)
- Parkinsonism (rigidity)
- Bradykinesia (slowness of movement)
- Tremor
- Tardive dyskinesia (irregular jerky movements of the mouth and extremities)
As you can see, these motor symptoms can be very disturbing to patients and their families. The benefits and risks must always be weighed when starting or continuing a first-generation antipsychotic. Laryngeal dystonia, for instance, can lead to acute respiratory failure and death if not detected early enough!
The second-generation antipsychotics:
- Aripiprazole
- Ziprasidone
- Risperidone
- Quetiapine
- Olanazpine
- Clozapine (the gold-standard, used as a last resort for treatment-resistant schizophrenia)
The unique medical side effects from second-generation antipsychotics include:
- Metabolic syndrome
- Diabetes mellitus
- Weight gain
- Hyperlipidemia (high cholesterol)
- Hypertension (high blood pressure)
- Cardiovascular disease
- Tonic-clonic seizures (with clozapine)
- Agranulocytosis (with clozapine)
- Myocarditis and dilated cardiomyopathy (with clozapine)
As you can see, a healthy psychiatric patient has the potential of becoming a lifelong diabetic after starting a second-generation antipsychotic. These are very serious side effects that must always be monitored for when a patient is started on a second-generation antipsychotic.
Overall, the side effects listed above do not present in all patients, but they must always be monitored for! Education, teamwork, coordination between different specialities and therapeutic physician-patient relationships are required for careful monitoring of potential side effects as well as successful treatments!
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