1. 11
Drugs for Psychoses

2. Directory
Classroom Response System
Lecture Note Presentation

3. Question 1
Which of the following symptoms does the nurse recognize as an anticholinergic effect of chlorpromazine (Thorazine)?

4. Question 1 Choices Hallucinations, illusions, paranoia
Hypertension, polyuria, increased salivation
Dry mouth, postural hypotension, urinary retention
Fever, flulike symptoms, decreased WBC count

5. Question 1 Answer Hallucinations, illusions, paranoia
Hypertension, polyuria, increased salivation
Dry mouth, postural hypotension, urinary retention
Fever, flulike symptoms, decreased WBC count

6. Question 2
The patient states that he has not taken his antipsychotic drug for the past 2 weeks because it was causing sexual dysfunction. The name antipsychotic explains that continuing the medication as prescribed is important because:

7. Question 2 Choices
Hypertensive crisis may occur with abrupt withdrawal.
Muscle twitching may occur.
Noncompliance may bring on parkinsonism.
Symptoms of psychosis are likely to return.

8. Question 2 Answer
Hypertensive crisis may occur with abrupt withdrawal.
Muscle twitching may occur.
Noncompliance may bring on parkinsonism.
Symptoms of psychosis are likely to return.

9. Question 3
The patient is on thioridazine (Mellaril) and has developed muscle spasms, difficulty sleeping, and a shuffling gait.

10. Question 3 Choices Anticholinergic effects Cholinergic effects
Extrapyramidal adverse effects
Serotonin syndrome

11. Question 3 Answer Anticholinergic effects Cholinergic effects
Extrapyramidal adverse effects
Serotonin syndrome

12. Question 4
Neuroleptic malignant syndrome (NMS) is most likely to occur with use of which of the following drugs?

13. Question 4 Choices Chlorpromazine (Thorazine) Thiothixene HCl (Navane)
Haloperidol (Haldol)
Clozapine (Clozaril)

14. Question 4 Answer Chlorpromazine (Thorazine) Thiothixene HCl (Navane)
Haloperidol (Haldol)
Clozapine (Clozaril)

15. Learning Outcomes Identify signs characteristic of psychosis.
Compare and contrast the positive and negative symptoms of schizophrenia.
Describe theories for the cause of schizophrenia.
Explain the importance of patient drug compliance in the pharmacotherapy of schizophrenia.

16. Learning Outcomes
Explain the symptoms associated with extrapyramidal adverse effects of antipsychotic drugs.
For each of the drug classes, know representative drug examples and explain their mechanism of action, primary actions, and important adverse effects.

17. Learning Outcomes
Explain the goals of pharmacotherapy and categorize drugs based on their classification and drug action.

18. Core Concept 11.1
Most psychoses have no identifiable cause and require long-term drug therapy.

19. Signs and Symptoms
Delusions (strong beliefs in something that is false or not based on reality)
Example: the patient may believe that someone is planting thoughts in his or her head.

20. Signs and Symptoms
Hallucinations (seeing, hearing, or feeling something that is not there)
Example: the patient may hear voices or see spiders crawling on walls that others around the patient do not see or hear.

21. Signs and Symptoms
Illusions (distorted or misleading perceptions of something that is actually real)
Example: the patient may see a shadow and believe it is really a person.

22. Signs and Symptoms Disorganized behavior
Example: the patient may wear clothes in an entirely inappropriate manner and for no apparent reason, such as dressing up with layers of clothes including a hat, sunglasses, and several pairs of socks over the hands and feet.

23. Signs and Symptoms Difficulty relating to others
Example: the patient may become withdrawn from other people in the room, showing signs of distress, maybe even turning combative if confronted or questioned. Behavior may range from total inactivity to extreme agitation.

24. Signs and Symptoms Paranoia
Example: the patient may have an extreme suspicion that he or she is being followed, or that someone is trying to kill him or her.

25. Core Concept 11.2
Schizophrenic patients experience many different symptoms that may change over time.

26. Schizophrenia A type of psychosis
abnormal thoughts and thought processes, disordered communication, withdrawal from other people and the outside environment, and a high risk for suicide.
Several subtypes of schizophrenic disorders are based on clinical presentation.

27. Positive Symptoms Hallucinations, delusions, or paranoia
Strange behavior, such as talking in rambling statements or making up words
Strange or irrational actions
Changes from stupor to extreme hyperactivity

28. Negative Symptoms
Attitude of indifference toward or detachment from life activities
Neglect of personal hygiene, job, and school
Noticeable withdrawal from social activities and relationships
Changes from extreme hyperactivity to stupor

29. Concept Review 11.1
What are the signs characteristic of schizophrenia?
What distinguishes a positive symptom from a negative symptom?

30. Concept Review 11.2
What are the major types of psychoses and how are they differentiated?
How are the symptoms of schizophrenia reduced?

31. Core Concept 11.3
The experience and skills of the healthcare provider are critical to the pharmacological management of psychoses.

32. Disease Management
The primary goal of pharmacotherapy for schizophrenic patients is to reduce psychotic symptoms to a level that allows the patient to maintain normal social relationships, including self-care and keeping a job.

33. Core Concept 11.4
Conventional antipsychotic drugs include the phenothiazines, phenothiazine-like drugs, and nonphenothiazines.

37. Extrapyramidal Adverse Effects(EPS)
Serious set of adverse reactions to antipsychotic drugs.
Symptoms include:
Acute dystonia
Occur early in the course of pharmacotherapy

38. Extrapyramidal Adverse Effects(EPS)
Severe muscle spasms, particularly of the back, neck, tongue, and face
Akathisia, the most common EPS, is an inability to rest or relax.
Parkinsonism include tremor, muscle rigidity, stooped posture, and a shuffling gait.
Tardive dyskinesia,

39. Extrapyramidal Adverse Effects(EPS)
Unusual tongue and face movements such as lip smacking and wormlike motions of the tongue.
If extrapyramidal effects are reported early and the drug is withdrawn or the dosage is reduced, the adverse effects can be reversible.

40. Extrapyramidal Adverse Effects(EPS)
With higher doses given for prolonged periods, the extrapyramidal symptoms may become permanent.

41. Core Concept 11.5
Atypical antipsychotic drugs and a newer drug class have been developed to better meet the needs of patients with psychoses.

43. Concept Review 11.3
What is a neuroleptic drug? What are the two general classes of drugs used to treat psychoses? How does each drug category generally affect positive and/or negative symptoms of schizophrenia?