Advanced Psychopharmacology

Advanced Psychopharmacology and Health Promotion

Unit 7 Medications for Psychosis and Schizophrenia Related Disorders 600W. APA. 4 references due 10-17-23.

Answer the following questions:

Which antipsychotics are considered first-generation and why are they used less often than second generation antipsychotics? Are second-generation antipsychotics more effective?

Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics.

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Use as a guide please do not copy this information. Also please use the textbook

  1. Which antipsychotics are considered first-generation and why are they used less often than second generation antipsychotics? Are second-generation antipsychotics more effective? First generation antipsychotics, also referred to as “typical antipsychotics” were developed in the 1950s. Commonly prescribed first-generation antipsychotics include: Loxitane (loxapine); Mellaril (thioridazine); Moban (molindone); Navane (thiothixene); Prolixin (fluphenazine); Serentil (mesoridazine); Stelazine (trifluoperazine); Trilafon (perphenazine); and Thorazine (chlorpromazine). These first-generation antipsychotics are used less often than second generation antipsychotics because these medications have a high risk of side effects and some of those side effects can be severe. Second-generation antipsychotics, also known as “atypical antipsychotics,” were developed in the 1980s. Second-generation antipsychotics have more metabolic symptoms, including obesity, diabetes and hyperlipidemia (Heldt, 2017; Stahl et al., 2021). Side effects from first-generation antipsychotics include extrapyramidal effects, such as tardive dyskinesia, rigidity, tremors, and seizures. There is no evidence that second generation antipsychotics are significantly more effective than first generation antipsychotics in the treatment of cognitive and negative symptoms of schizophrenia (Stahl et al., 2021; Stroup, et al., 2003). 2. Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics. Tardive dyskinesia is one of the symptoms of long-term use of a first -generation antipsychotic. It is a condition where there is constant or rhythmic involuntary movements that usually involves the muscles of the mouth. It can appear as lip smacking, chewing, excessive eye blinking, grimacing. These symptoms appear slowly over time. Tardive dyskinesia will not go away once the antipsychotic is stopped, it can become irreversible if present for too long. The risk of a patient developing tardive dyskinesia goes up with every year of continuous treatment. TD is specific to the use of antipsychotics (Heldt, 2017). Acute dystonia can develop within the first few hours of a patient receiving an antipsychotic. It is a sustained and painful involuntary contraction of a muscle group- usually involving the face or neck muscles. This is an easily reversible side effect and is managed with an anticholinergic drug such as Benadryl or Cogentin. This condition This study source was downloaded by 100000769192234 from CourseHero.com on 10-16-2023 17:34:58 GMT -05:00 https://www.coursehero.com/file/123197773/Discussion-7docx/ can resolve within a few minutes of proper medication and will not leave any long-term effects (Heldt, 2017). Athetosis is slow, involuntary, writhing movements of fingers, hands, toes and feet. Patients with this condition cannot maintain a stable or still position and when patients attempt to try to control the movements, symptoms can get worse. Athetosis is often a longterm symptom of continued use of first-generation antipsychotics (Holland, 2018). Tics are distinguished from EPS symptoms by the fact that tics are most commonly brief movements are able to be suppressed. Tics are sudden, rapid and repetitive movement (motor tics) or vocalizations (vocal tics). Those with tics feel the urge building up inside them before the tic appears, they these individuals report a feeling of relief after the tic is over. Although tics are involuntary, tics stop during sleep and patients can suppress the urge for short periods of time with effort (Martino, 2020). Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform. Holland, K. (2018, July 18). What Is Athetosis? Healthline; Healthline Media. https://www.healthline.com/health/athetosis Martino, D. (2020). Update on the Treatment of Tics in Tourette Syndrome and Other Chronic Tic Disorders. Current Treatment Options in Neurology, 22(4). https://doi.org/10.1007/s11940-020-0620-z Stahl, S., Muntner, N., & Grady, M. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and clinical applications (5th ed.). Cambridge University Press. Stroup, T. S., McEvoy, J. P., Swartz, M. S., Byerly, M. J., Glick, I. D., Canive, J. M., McGee, M. F., Simpson, G. M., Stevens, M. C., & Lieberman, J. A. (2003). The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)

Advanced Psychopharmacology

  1. First-Generation vs. Second-Generation Antipsychotics: First-generation antipsychotics, also known as “typical antipsychotics,” include medications like Thorazine (chlorpromazine), Prolixin (fluphenazine), and Haldol (haloperidol). These medications were developed in the 1950s and were the first to be used in the treatment of schizophrenia and related disorders.

    First-generation antipsychotics are used less often than second-generation antipsychotics because they have a higher risk of side effects. Common side effects of first-generation antipsychotics include extrapyramidal symptoms (EPS), such as tardive dyskinesia, dystonia, rigidity, tremors, and seizures. These side effects can be severe and sometimes irreversible.

    Second-generation antipsychotics, or “atypical antipsychotics,” were developed in the 1980s and include medications like Risperdal (risperidone), Zyprexa (olanzapine), and Abilify (aripiprazole). Second-generation antipsychotics are used more often today because they have a more favorable side effect profile in terms of extrapyramidal symptoms. However, they are associated with metabolic symptoms such as obesity, diabetes, and hyperlipidemia.

    Regarding their efficacy, there is no clear evidence that second-generation antipsychotics are significantly more effective than first-generation antipsychotics in treating cognitive and negative symptoms of schizophrenia. The choice between first-generation and second-generation antipsychotics depends on individual patient factors and the balance of risks and benefits (Stahl et al., 2021; Stroup et al., 2003).

  2. Comparison of Extrapyramidal Symptoms (EPS):
    • Tardive Dyskinesia (TD): TD is a side effect of long-term use of first-generation antipsychotics. It involves involuntary movements, often in the muscles of the face, leading to symptoms like lip smacking, chewing, and excessive eye blinking. TD develops slowly and can become irreversible if present for an extended period.
    • Acute Dystonia: Acute dystonia can occur shortly after starting an antipsychotic, typically within a few hours. It involves sustained and painful involuntary muscle contractions, often affecting the face or neck muscles. This condition is easily reversible with anticholinergic medications.
    • Athetosis: Athetosis is characterized by slow, writhing, and involuntary movements of fingers, hands, toes, and feet. These movements are difficult to control, and trying to do so can exacerbate the symptoms. Athetosis is often a long-term symptom associated with the continued use of first-generation antipsychotics (Holland, 2018).
    • Tics: Tics are different from EPS symptoms in that they are typically brief, rapid, repetitive movements (motor tics) or vocalizations (vocal tics). Individuals with tics often feel an urge building up before the tic occurs, and they can sometimes suppress the urge for short periods (Martino, 2020).

In conclusion, it’s essential to choose antipsychotic medications carefully, considering both their efficacy and side effect profiles. The choice between first-generation and second-generation antipsychotics should be individualized based on the patient’s specific needs and tolerance for side effects. Additionally, the risk of developing different EPS conditions should be monitored when prescribing and using these medications.

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