Antipsychotics Classification and Guidelines Update
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Questions and Answers

What major global event significantly impacted the lives of billions and the healthcare sector?

  • Economic recession
  • Climate change
  • The rise of technology in healthcare
  • The COVID-19 pandemic (correct)

    • What was Thioridazine widely described as in the 1980s?

  • Dopamine receptor antagonist
  • Atypical antipsychotic
  • Conventional phenothiazine (correct)
  • Second-generation antipsychotic

    • What remains a vital imperative during and after the pandemic despite the focus on physical health?

  • Chronic disease management
  • The optimal treatment of mental illness (correct)
  • Physical rehabilitation
  • Nutritional interventions

    • Which section was notably included in the latest edition of The Guidelines?

    <p>Psychotropics at the end of life</p> Signup and view all the answers

    Which drug is characterized as just about as 'typical' as a drug can be?

    <p>Risperidone</p> Signup and view all the answers

    What commonality ties so-called atypical antipsychotics together?

    <p>D2 receptors preference outside the striatum</p> Signup and view all the answers

    What is a notable change in the 14th edition of The Guidelines compared to previous editions?

    <p>Thorough updates including new psychotropic drugs</p> Signup and view all the answers

    Who is recognized for contributions on the use of clozapine in the latest edition?

    <p>Siobhan Gee</p> Signup and view all the answers

    What is the primary problem with the FGA/SGA classification?

    <p>It solely refers to the time of introduction</p> Signup and view all the answers

    Which of the following drugs was synthesized in 1959?

    <p>Clozapine</p> Signup and view all the answers

    What contribution is Emily Finch known for in the context of The Guidelines?

    <p>Writing the chapter on addictions</p> Signup and view all the answers

    Which agent mentioned does not cause EPS but has little in common with other atypicals?

    <p>Pimavanserin</p> Signup and view all the answers

    What challenge were authors of The Guidelines likely facing during the book's writing process?

    <p>Risk of infection from COVID-19</p> Signup and view all the answers

    What has been conserved more due to convention than scientific basis in the guidelines?

    <p>FGA/SGA distinction</p> Signup and view all the answers

    Which contributor is acknowledged for their work on older adults in this edition?

    <p>Delia Bishara</p> Signup and view all the answers

    What does the distinction between first- and second-generation antipsychotics rely on?

    <p>Time of introduction</p> Signup and view all the answers

    What is the maximum daily dose of risperidone according to the EMA labelling?

    <p>16mg/day</p> Signup and view all the answers

    What is the maximum dose of chlorpromazine per day?

    <p>1000mg/day</p> Signup and view all the answers

    Which of the following drugs has a maximum dose of 2400mg per day?

    <p>Sulpiride</p> Signup and view all the answers

    What is the maximum monthly dose for the depot form of risperidone?

    <p>50mg every 2 weeks</p> Signup and view all the answers

    Which antipsychotic has the highest maximum dose among the listed options?

    <p>Clozapine</p> Signup and view all the answers

    What is the maximum allowable dose of ziprasidone per day?

    <p>160mg/day</p> Signup and view all the answers

    Among the following, which drug's maximum dose is restricted to 20mg/day in its sublingual form?

    <p>Asenapine</p> Signup and view all the answers

    Which long-acting injection of aripiprazole has a maximum dose of 400mg/month?

    <p>Aripiprazole depot</p> Signup and view all the answers

    What is the maximum dose of levomepromazine per day?

    <p>1200mg/day</p> Signup and view all the answers

    What is the maximum daily dose of iloperidone?

    <p>24mg/day</p> Signup and view all the answers

    Which type of antipsychotics are compared in the efficacy and safety for first-episode psychosis in the systematic review by Zhang JP et al.?

    <p>Individual second-generation vs. first-generation antipsychotics</p> Signup and view all the answers

    What does the meta-analysis by Leucht S et al. conclude about second-generation antipsychotic drugs for schizophrenia?

    <p>They have higher tolerability than first-generation antipsychotics</p> Signup and view all the answers

    What is the main focus of the publication by Huhn M et al. regarding antipsychotics?

    <p>The efficacy and tolerability of 32 oral antipsychotics</p> Signup and view all the answers

    What does the research by Samara MT et al. investigate regarding treatment-resistant schizophrenia?

    <p>The efficacy, acceptability, and tolerability of antipsychotics</p> Signup and view all the answers

    According to Taylor DM, what is the current status of clozapine in treating treatment-resistant schizophrenia?

    <p>It is still considered the gold standard</p> Signup and view all the answers

    Which of the following studies conducted a meta-analysis of the efficacy of second-generation antipsychotics?

    <p>Davis JM et al.</p> Signup and view all the answers

    What was a finding in the systematic review conducted by Leucht S et al. regarding placebo-controlled trials in acute schizophrenia?

    <p>Efficacy predictors were identified through meta-regression</p> Signup and view all the answers

    Which antipsychotic is highlighted by Siskind D et al. for its effectiveness in treatment-refractory cases?

    <p>Clozapine</p> Signup and view all the answers

    What is the focus of the systematic review conducted by Leucht S et al.?

    <p>Effectiveness of antipsychotic drugs versus placebo</p> Signup and view all the answers

    Which antipsychotic-related adverse effect was investigated in the study by Sorensen HJ et al.?

    <p>Hip fracture risk</p> Signup and view all the answers

    What aspect of antipsychotic medication was addressed by Waddell L et al.?

    <p>Self-rating scale for atypical side effects</p> Signup and view all the answers

    What major limitation in the treatment of schizophrenia is discussed by Falkai P?

    <p>Reasons why patients switch therapies</p> Signup and view all the answers

    Which element is compared in the review by Leucht C et al.?

    <p>Oral versus depot formulations of antipsychotic drugs</p> Signup and view all the answers

    What side effect prevalence was studied by Yusufi B et al. during clozapine treatment?

    <p>Side effects related to clozapine dose</p> Signup and view all the answers

    What is the primary topic of the study by Pope A et al.?

    <p>Adverse effects assessment methods</p> Signup and view all the answers

    Which study addresses the risk of venous thromboembolism during antipsychotic treatment?

    <p>Masopust J et al.</p> Signup and view all the answers

    Study Notes

    Introduction

    • The 14th edition of The Guidelines was published during the COVID-19 pandemic.
    • The authors express gratitude to contributors for their work amidst the challenging conditions.
    • Mental health issues remain a significant concern, particularly in the context of the pandemic.
    • This edition incorporates new research and medications since 2017.
    • It includes new sections on subjects such as agitated delirium, psychotropics at the end of life, intravenous psychotropic formulations, intramuscular clozapine and weekly oral penfluridol.

    Antipsychotics Classification

    • The typical/atypical dichotomy used to classify antipsychotics is not well-defined.
    • Some drugs initially classified as atypical (e.g., thioridazine, sulpiride) are now considered conventional.
    • Risperidone, at high doses, exhibits properties similar to typical antipsychotics.
    • Atypical antipsychotics are not a homogenous group in terms of pharmacology or chemistry.
    • While some atypical agents exhibit improved efficacy and lower extrapyramidal symptoms (EPS), they also have limitations.
    • The introduction of newer agents like pimavanserin with antipsychotic activity and low EPS does not fit into the atypical category.

    First- and Second-Generation Antipsychotics

    • The FGA/SGA classification system has been adopted to address the limitations of the typical/atypical approach.
    • All antipsychotics introduced since 1990 are classified as SGAs (atypical).
    • The FGA/SGA classification is based on the time of introduction, which may not be a reliable indicator of pharmacological properties.
    • The date of introduction can be significantly different from the date of first synthesis.
    • The FGA/SGA distinction is maintained in this edition for convention despite its scientific limitations.

    Licensed Maximum Doses of Antipsychotics

    • The text provides a table outlining the licensed maximum doses of antipsychotics in the EU as of February 2021.
    • The list includes both oral and long-acting injectable antipsychotics.

    Maximum Doses of Antipsychotics Outside the EU

    • A separate table details the licensed maximum doses of antipsychotics available outside the EU (FDA approved) as of February 2021.
    • This list includes both oral and long-acting injectable antipsychotics.
    • Note: Some drugs are available only in specific regions.

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    The Maudsley Prescribing Guidelines in Psychiatry (2021) PDF

    Description

    Explore the latest insights from the 14th edition of The Guidelines, focusing on antipsychotic classifications during the COVID-19 pandemic. Understand the evolving definitions of typical and atypical antipsychotics and the relevant new research that has emerged since 2017. This quiz covers key topics including new treatments and mental health challenges faced today.

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