The primary treatment for schizophrenia is psychopharmacology. Antipsychotic medications, also known as neuroleptics, are prescribed to decrease psychotic symptoms. Conventional antipsychotics target positive symptoms like delusions and hallucinations by blocking dopamine, while atypical antipsychotics also target negative symptoms by blocking serotonin. Common side effects of antipsychotics include extrapyramidal symptoms like dystonia, akathisia, and tardive dyskinesia. Clozapine is effective but carries the risk of the potentially fatal agranulocytosis if white blood cell counts are not regularly monitored. Long-acting injectable forms of fluphenazine and haloperidol can be used for maintenance therapy

1. SCHIZOPHRENIA
Psychopharmacology

2. Psychopharmacology
The primary medical treatment for
schizophrenia is PSYCHOPHARMACOLOGY.
In the past:
 Electroconvulsive therapy
 Insulin Shock therapy
 Psychosurgery

3. Electroconvulsive Therapy

4. Insulin Shock Therapy

5. Psychosurgery

6. Antipsychotic medications
( Neuroleptics)
 Chlorpromazine ( Thorazine ) , are
prescribe primarily to for their efficacy in
decreasing psychotic symptoms . They do
not cure schizophrenia rather they are used
to manage symptoms.
 Conventional antipsychotic medications are
DOPAMINE antagonist.

7. Conventional Antipsychotics
These drugs are dopamine antagonists. They target positive
signs of schizophrenia such as delusions, hallucinations,
disturbed thinking and other psychotic symptoms.
Thioridazine
Mellaril, Melleril, Novoridazine, Thioril
Mesoridazine
Serentil
Levomepromazine
Nosinan, Nozinan, Levoprome
Loxapine
Loxapac, Loxitane
Molindone
Moban
Perphenazine
Trilafon
Thiothixene
Navane
Trifluoperazine
Stelazine
Haloperidol
Haldol
Fluphenazine
Prolixin
Droperidol
Droleptan, Dridol, Inapsine, Xomolix, Innovar (+Fentanyl)
Zuclopenthixol
Clopixol
Prochlorperazine
Compazine, Stemzine, Buccastem, Stemetil, Phenotil

8. Atypical Antipsychotics
These drugs are dopamine and serotonin antagonists, they not
only diminish positive symptoms but also lessen the negative signs
of lack of volition and motivation, and social withdrawal.
Clozapine
Clozaril
Iloperidone
Fanapt
Lurasidone
Latuda
Mosapramine
Cremin
Olanzapine
Zyprexa, Ozace
Paliperidone
Invega
Perospirone
Lullan
Quetiapine
Seroquel
Remoxipride
Roxiam
Risperidone
Risperdal, Zepidone
Sertindole
Serdolect
Sulpiride
Sulpirid, Eglonyl
Ziprasidone
Geodon, Zeldox

9. Maintenance Therapy are available in
depot injection forms.
Two medications are available in depot injection
forms for maintenance therapy:
Fluphenazine (PROLIXIN) in decanoate
Haloperidol (HALDOL)in decanoate
 The effects of medications are absorbed slowly over time
in the client’s system, the depot injection is sesame oil.
 The effects of these medications last for 2-4 weeks,
eliminating the need for daily oral antipychotic medication.
 The duration of action is 7-28 days for FLUPHENAZINE
 4 weeks for HALOPERIDOL.

10. SIDE EFFECTS:
Serious neurologic side effects include :
Extrapyramidal side effects
Acute dystonic reactions
Akathisia
Parkinsonism/ Pseudo parkinsonism
Tardive Dyskinesia
Seizures
Neuroleptic Malignant Syndrome

11. Extrapyramidal Effects

12. Extrapyramidal Side effects:
EPS are reversible movement disorders induced by
neuroleptic medication.
DYSTONIC reactions to antipsychotic medications appear
early in the course of treatment and are characterize by
spasms in discrete muscle groups such as the neck
muscles (Torticollis) or eye muscles (oculogyric crisis).
These spasms also may be accompanied by protrusion of
the tongue, dysphagia, laryngeal, pharyngeal spasms
that can compromise the client’s airway, causing medical
emergency.
Acute treatment consists of diphenhydramine (Benadryl)
given either IM or IV, or Benzotropin (Cogentin) given IM.

13. Pseudoparkinsonism
PSEUDOPARKINSONISM or
Neuroleptic-induced parkinsonism,
includes shuffling gait, mask like
Facies, muscle stiffness or
cogwheeling rigidity and drooling.

14. AKATHISIA

Characterized by restless movement,
pacing, inability to remain still, and the
client’s report of inner restlessness.
Clients are very uncomfortable with
these sensations and may stop taking
the antipsychotic medication to avoid
these side effects.
Treatment: Betablockers such as
propanolol have been the most
effective in treating akathisia,
whereas Benzodiazepines have
provided some success as well.

15. Tardive Dyskinesia
 A late appearing side effect of
antipsychotic medications, is
characterized by abnormal,
involuntary movements such as lip
smacking, tongue protrusion,
chewing, blinking, grimacing and
choreiform movements of the
limbs and feet.
These movements are
embarrassing for the clients and
may cause them to become more
socially isolated, decreasing or
discontinuing the medication can
arrest the progression.

16. Tardive Dyskinesia
Clozapine (Clozaril),
an atypical
antipsychotic drug
has not been found to
cause this side effect,
so it often
recommended for
clients who have
experienced tardive
dyskinesia while
taking conventional
antipsychotic drugs.

17. Screening clients for late appearing movement disorder – important!

18. ABNORMAL INVOLUNTARY MOVEMENT SCALE
* The client is observed for several positions
and the severity of symptoms is rated from 0-4.
* The AIMS can be administered every 3-6
months.
If the nurse detects an increase in score on the
AIMS, indicating increased symptoms of tardive
dyskinesia, he or she should notify the physician
so that the client’s dosage of the drug can be
changed to prevent advancement of tardive
dyskinesia.

19. Seizures are an SEIZURE
infrequent side effect
associated with the
antipsychotic drugs.
Seizures may be
associated with higher
doses of the
medication.
Treatment is a lowered
dosage or a different
antipsychotic
medications.

20. Neuroleptic Malignant Syndrome
 Is a serious and frequently
fatal condition seen in those
being treated with
antipsychotic medications.
Characterized by muscle
rigidity, high fever, increased
muscle enzymes(particularly
creatine phosphokinase), and
leukocytosis (increased
leukocytes)
This can be treated by
stopping antipsychotic
medications. The clients ability
to tolerate other antipsychotic
medications after NMS varies
but use of another
antipsychotic appears possible
in most instances.

21. Agranulocytosis
Clozapine has the potentially fatal
side effect of agranulocytosis
(failure of the bone marrow to
produce adequate white blood
cells).
Agranulocytosis suddenly develops
characterized by fever, malaise
ulcerative sore throat and
leukopenia.
The drug must be discontinued
immediately.
Must have weekly WBC counts.

22. Agranulocytosis
• WBC must be assessed
weekly for the first 6
months of clozapine
therapy and every 2 weeks
thereafter.
• Clozapine is dispensed every
7-14 days only and evidence
of the WBC above
3000cells/mm3 is required
before a refill is furnished.

23. END