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Clinical Uses of Antipsychotics and Drug Induced Dyskinesia

by Pravin Shukle, MD
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    00:01 What about disease like mania and Tourette's syndrome? We often use lithium in the treatment of mania and sometimes we will use these new agents in combination with lithium. These drugs are approved in bipolar disorder and in Tourette's syndrome.

    00:19 I mention Tourette's syndrome in a later lecture and we will cover it more detail then. Molinidine is used in Tourette's syndrome but never in schizophrenia. So we're gonna cover Tourette's syndrome in our muscle lecture later on. But just remember that this particular agent is not used in the antipsychotic world at all. The treatment of psychosis in patients with Alzheimer's disease and Parkinsonianism is particularly challenging. So if you go back to the dopamine model that I had shown you before, you know that increasing dopamine for Parkinson's disease may help the Parkinson's disease but it can make your psychosis worst. The opposite is true when you decrease dopamine levels. Decreasing dopamine levels can make your Parkinson's disease much worst but improve your psychosis symptoms. So it's a real challenge treating psychosis in patients who have Parkinson's disease for example. That's why this newer atypical agents are so helpful because they are actually approaching the serotonin portion of our understanding of how psychosis works. And that's why in patients who have Parkinson's disease and to a lesser extent Alzheimer's disease, we use these new agents to treat their psychosis. Let's move on to emesis and nausea. Remember that these agents are also active in the chemoreceptor trigger zone which houses the vomiting center of the brain. In fact most phenothiazine antipsychotic agents have very good anti-emetic properties. A classical example is Stemetil which is an agent that we use all the time in nausea particularly in patients who have been given chemotherapy agents and they are really nauseous from the treatment of their chemotherapy. There is a specific issue that I think we need to cover when we are talking about antipsychotic medications and that is a drug induced dyskinesia. This is kind of a unique side effects from these drugs. You can get an acute dystonia that's caused by antipsychotics. Remember that benztropine is the antidote to that reaction. Tardive dyskinesia may be due to D2 receptor damage or dysfunction and fetal alcohol syndrome patients may develop tardive dyskinesia after only one dose of an antipsychotic.

    02:57 So you have to be particularly aware of the side effects of these medication and the motor dyskinesias that you can get or induced by giving even as little as one pill. Listen, tardive dyskinesia is very hard to treat. We use drugs like clonazepam and others to try and treat the tardive dyskinesia that we have induced. But in general, they are hard to treat, they are resistant to treatment. Withdrawal of the offending agent is obviously going to be your first line treatment.


    About the Lecture

    The lecture Clinical Uses of Antipsychotics and Drug Induced Dyskinesia by Pravin Shukle, MD is from the course CNS - Pharmacology. It contains the following chapters:

    • Clinical Uses of Antispychotics
    • Non-parkinsonian Movement Disorders - Drug Induced Dyskinesia

    Included Quiz Questions

    1. Increases risk of psychosis vis dopaminergic tracts of the brain.
    2. Increases risk of developing hyporprolactinemia.
    3. Increase risk of developing negative symptoms of schizophrenia
    4. Reduce feelings of nausea
    5. Reduce risk of developing positive symptoms of schizophrenia
    1. A 35 year old male with a long history of schizophrenia and antipsychotic, diagnosed with tardive dyskinesia.
    2. A 7 year old with verbal outbursts, diagnosed with Tourette's syndrome.
    3. A 85 year old woman with shuffling gait and pill rolling tremor, diagnosed with Parkinson's disease.
    4. A 92 year old man with trouble remembering recent and past events and trouble with activities of daily living, diagnosed with Alzheimer's disease.
    5. A 21 year old woman with a history of hallucinations and severe anxiety, diagnosed with schizophrenia.
    1. Valproic acid (anti-seizure medication)
    2. Benztropine (Anticholinergic medication)
    3. Clonazepam (Benzodiazepine)
    4. Clozapine (Atypical antipsychotic)
    5. Risperidone (Atypical antipsychotic)

    Author of lecture Clinical Uses of Antipsychotics and Drug Induced Dyskinesia

     Pravin Shukle, MD

    Pravin Shukle, MD


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