Antipsychotics

Antipsychotic medications are effective in reducing or alleviating symptoms of psychosis, including delusions and hallucinations. They are primarily utilized in the treatment of schizophrenia but are also employed for managing psychosis in bipolar disorder, severe depression, delirium, and Alzheimer’s disease. Additionally, antipsychotics play a role in stabilizing moods in bipolar disorder and mitigating anxiety symptoms in anxiety disorders when administered in smaller doses.

In cases of acute psychosis, antipsychotic medications aid in alleviating confusion and can promote mental clarity within a few days of initiation. While they effectively control symptoms such as hallucinations, it’s important to note that they do not cure the underlying psychiatric condition. However, when taken over an extended period, antipsychotics can help prevent future episodes of psychosis.

A comprehensive approach combining antipsychotic medication with other therapeutic interventions and support services can significantly enhance the management of psychotic symptoms and improve overall quality of life. This may include family therapy, peer support, occupational therapy, as well as assistance with housing and employment opportunities.

Psychosis is thought to stem from an excessive activity or elevated levels of dopamine, a neurotransmitter in the brain. Substances like cocaine, which elevate dopamine levels, can induce psychosis during acute intoxication. Antipsychotic medications counteract this heightened dopamine effect by blocking its activity. As a result, psychotic symptoms either diminish significantly or resolve completely.

Individuals experiencing a partial response to antipsychotic treatment may still encounter auditory hallucinations and hold delusional beliefs. However, they often exhibit improved insight, allowing them to recognize the unreality of their experiences to a greater extent. Additionally, they demonstrate enhanced ability to redirect their attention towards various aspects of their lives, such as family, relationships, career, or academic pursuits.

Antipsychotic medications are generally divided into two categories:

• atypical (second generation) antipsychotics
• typical (first generation) antipsychotics

These medications are commonly administered orally in tablet or liquid form, although some are available as injectables. Long-lasting (depot) injections are also available, with durations ranging from one week to up to one month. The primary distinction between the two categories lies in their mechanism of action. First-generation antipsychotics primarily block dopamine receptors, while second-generation antipsychotics not only block dopamine receptors but also modulate serotonin levels. Second-generation antipsychotics are often preferred due to their reduced side effects and potential efficacy in addressing mood-related symptoms such as depression, attributed to their serotonin modulation.

Atypical (second generation) antipsychotics

The second generation of antipsychotics are typically the preferred choice for treatment. While they may not always be officially approved for these purposes, they are frequently utilized in the management of mood and anxiety disorders, including bipolar disorder, posttraumatic stress disorder, and obsessive-compulsive disorders.

Medications available in this class include:

• risperidone (Risperdal)
• quetiapine (Seroquel)
• olanzapine (Zyprexa)
• ziprasidone (geodon)
• paliperidone (Invega)
• aripiprazole (Abilify)
• clozapine (Clozaril)

Clozapine is exceptional in that it often works when other medications have failed. It is not the first choice for antipsychotics due to blood monitoring protocols.

Typical (first generation) antipsychotics

These older medications include:

• haloperidol (Haldol)
• perphenazine (Trilafon)
• trifluoperazine (Stelazine)
• thiothixene (Navane)
• fluphenazine (prolixin)