Podcast
Questions and Answers
Patients typically have negative views of depot medication.
Patients typically have negative views of depot medication.
False (B)
Considering compliance aids is always an adequate solution for poor medication adherence.
Considering compliance aids is always an adequate solution for poor medication adherence.
False (B)
Switching to an antipsychotic medication with a more favorable side-effect profile is a recommended approach for poorly tolerated treatment.
Switching to an antipsychotic medication with a more favorable side-effect profile is a recommended approach for poorly tolerated treatment.
True (A)
Depot or long-acting injectable (LAI) antipsychotic medications should only be considered if the patient has complete insight into their condition.
Depot or long-acting injectable (LAI) antipsychotic medications should only be considered if the patient has complete insight into their condition.
Simplifying the drug regimen can help address forgetfulness or disorganization in patients.
Simplifying the drug regimen can help address forgetfulness or disorganization in patients.
In the treatment algorithm for first-episode schizophrenia, the initial choice of antipsychotic medication should always be discussed with the patient and/or carer.
In the treatment algorithm for first-episode schizophrenia, the initial choice of antipsychotic medication should always be discussed with the patient and/or carer.
The minimum effective dose is assessed immediately after starting treatment without any waiting period.
The minimum effective dose is assessed immediately after starting treatment without any waiting period.
If a first-episode schizophrenia patient does not respond to the initial treatment within 2–3 weeks, clozapine is the recommended next step.
If a first-episode schizophrenia patient does not respond to the initial treatment within 2–3 weeks, clozapine is the recommended next step.
Patients experiencing poor medication adherence due to side effects should switch to a drug with a more favorable side-effect profile.
Patients experiencing poor medication adherence due to side effects should switch to a drug with a more favorable side-effect profile.
The early use of depot/long-acting injections is unlikely to affect relapse and readmission rates in first-episode schizophrenia patients.
The early use of depot/long-acting injections is unlikely to affect relapse and readmission rates in first-episode schizophrenia patients.
Amisulpride has a low incidence of weight gain.
Amisulpride has a low incidence of weight gain.
Aripiprazole is associated with a high level of prolactin elevation.
Aripiprazole is associated with a high level of prolactin elevation.
Chlorpromazine is linked to high levels of sedation.
Chlorpromazine is linked to high levels of sedation.
One of the side effects of Clozapine is significant weight gain.
One of the side effects of Clozapine is significant weight gain.
Lumateperone is associated with moderate parkinsonism.
Lumateperone is associated with moderate parkinsonism.
Iloperidone is linked to an increased risk of akathisia.
Iloperidone is linked to an increased risk of akathisia.
Risperidone has a high incidence of hypotension.
Risperidone has a high incidence of hypotension.
Pimozide exhibits a low possibility of causing anti-cholinergic effects.
Pimozide exhibits a low possibility of causing anti-cholinergic effects.
Zuclopenthixol is associated with significant akathisia.
Zuclopenthixol is associated with significant akathisia.
Paliperidone carries a very low risk of sedation.
Paliperidone carries a very low risk of sedation.
First-generation antipsychotic medications are preferred as the first-line treatment due to their higher efficacy compared to second-generation antipsychotics.
First-generation antipsychotic medications are preferred as the first-line treatment due to their higher efficacy compared to second-generation antipsychotics.
Clozapine should be considered after confirming treatment resistance with at least one trial of antipsychotic medication.
Clozapine should be considered after confirming treatment resistance with at least one trial of antipsychotic medication.
Adding a short-term sedative to the treatment regimen can be beneficial in acute exacerbations of schizophrenia.
Adding a short-term sedative to the treatment regimen can be beneficial in acute exacerbations of schizophrenia.
Discussing medication choices with patients or their carers is not considered necessary in acute treatment scenarios.
Discussing medication choices with patients or their carers is not considered necessary in acute treatment scenarios.
Movement disorders, such as tardive dyskinesia, are more commonly associated with second-generation antipsychotics than with first-generation antipsychotics.
Movement disorders, such as tardive dyskinesia, are more commonly associated with second-generation antipsychotics than with first-generation antipsychotics.
Patients who are given an informed choice about their medication tend to have worse outcomes than those who are not.
Patients who are given an informed choice about their medication tend to have worse outcomes than those who are not.
Prior treatment failure should be fully confirmed before switching to medication options like olanzapine or risperidone.
Prior treatment failure should be fully confirmed before switching to medication options like olanzapine or risperidone.
Time to response is shorter in cases of multi-episode schizophrenia exacerbation compared to single-episode cases.
Time to response is shorter in cases of multi-episode schizophrenia exacerbation compared to single-episode cases.
Study Notes
Relative Adverse Effects of Antipsychotic Medications
- Amisulpride has a moderate risk of weight gain and a high risk of prolactin elevation.
- Aripiprazole, Brexpiprazole, Cariprazine, Iloperidone, Lurasidone and Pimavanserin have a very low risk of adverse effects.
- Asenapine has a low risk of sedation and a moderate risk of weight gain.
- Benperidol has a high risk of sedation, akathisia, parkinsonism and prolactin elevation.
- Chlorpromazine, Clozapine, Flupentixol, Fluphenazine, Haloperidol, Paliperidone, Perphenazine, Promazine, Trifluoperazine and Zuclopenthixol have a high risk of sedation, akathisia, parkinsonism and prolactin elevation.
- Clozapine has a high risk of weight gain.
- Fluphenazine has a low risk of sedation.
- Haloperidol has a high risk of sedation, anticholinergic effects and prolactin elevation.
- Lumateperone has a moderate risk of sedation, weight gain and prolactin elevation.
- Loxapine has a moderate risk of sedation and weight gain.
- Olanzapine has a high risk of sedation, weight gain and prolactin elevation.
- Pimozide has a low risk of sedation and a moderate risk of prolactin elevation.
- Pipothiazine has a moderate risk of sedation, weight gain and prolactin elevation.
- Quetiapine has a high risk of sedation.
- Risperidone has a moderate risk of weight gain and hypotension.
- Sertindole has a high risk of parkinsonism and prolactin elevation.
- Ziprasidone has a low risk of sedation and a moderate risk of anticholinergic effects and prolactin elevation.
Treatment Algorithm for Poor Adherence to Antipsychotic Medication
- If the patient is forgetful or disorganized simplify drug regimen, reduce anticholinergic load, consider compliance aids and consider depot/LAI treatment.
- If the patient lacks insight or support discuss with the patient and consider depot/LAI.
- If the patient is poorly tolerating treatment discuss with the patient and switch to a drug with a more favorable side-effect profile.
Treatment Algorithm for First-Episode Schizophrenia
- Agree on the choice of antipsychotic medication with the patient and/or carer.
- If this is not possible, start with a second-generation antipsychotic medication.
- Titrate the dose to the minimum effective dose.
- Adjust dosage regimen according to therapeutic response and tolerability/safety.
- Assess over 2–3 weeks.
- If the medication is effective continue at the established effective dose, consider switching to depot/long-acting injection before discharge.
- If there is no effect after 2-3 weeks change the drug.
- If the medication is not tolerated or there is poor medication adherence, discuss with the patient and change the drug if the poor adherence is related to poor tolerability or consider early use of depot/long-acting injection if the poor adherence is related to other factors.
- If the medication is not effective after 2-3 weeks consider Clozapine.
Treatment Algorithm for Relapse or Acute Exacerbation of Schizophrenia
- Investigate social or psychological precipitants.
- Provide appropriate support and/or therapy.
- Continue usual drug treatment.
- Consider adding a short-term sedative or switching to a different, more acceptable antipsychotic medication.
- Discuss medication choice with the patient and/or carer.
- Assess over 6–8 weeks.
- If treatment is ineffective switch to Clozapine.
Notes on Treatment for Relapse or Acute Exacerbation of Schizophrenia
- First-generation drugs may be slightly less efficacious than some SGAs.
- FGAs should probably be reserved for second-line use due to the possibility of poorer outcomes compared with SGAs and a higher risk of movement disorder, particularly tardive dyskinesia.
- Choice should be based largely on comparative adverse effect profile and relative toxicity.
- Patients seem able to make informed choices based on these factors, although in practice they have been involved very rarely in drug choice.
- Allowing patients informed choice seems to improve outcomes.
- Where there is prior treatment failure (but not confirmed treatment refractoriness), olanzapine or risperidone may be better options than quetiapine.
- Olanzapine, due to evidence suggesting slight superiority over other antipsychotics, should likely be tried before clozapine unless contraindicated.
- Before considering clozapine, ensure adherence to prior therapy using depot/LAI formulation or plasma drug level monitoring of oral treatment.
- Time to response is increased, and total response decreased in exacerbation of multi-episode schizophrenia.
- Where there is confirmed treatment resistance (failure to respond to adequate trials of at least two antipsychotic medications), evidence supporting the use of clozapine (and only clozapine) is overwhelming.
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Description
This quiz assesses your knowledge of the relative adverse effects of various antipsychotic medications. You will learn about the risks associated with medications like Amisulpride, Clozapine, and Haloperidol, as well as their effects on weight gain, sedation, and prolactin elevation. Test your understanding of this essential aspect of psychopharmacology.
