1) Delerium

2) Paranoia

3) Hallucination (esp. auditory)

1) Low working memory.

2) Low attention.

3) Low Executive fxn.

1) Apathy

2) Withdrawal

3) Anhedonia (lack of pleasure)

Chlorpromazine

Phenothiazide Tricyclic

MECH: Blocks postsynaptic mesolimbic dopaminergic receptors in the brain.

USE: Tmnt. of positive symptoms (hallucinations, delusions). Little effect on neg. sympt.

AE: Sedation, postural hypotension, weight gain, anticholinergic effects. Also sexual dysfunction, hyperprolactinemia, tardive dyskinesia (facial tics -- treat with tetrabenazine), neuroleptic malignant syndrome (NMS).

FALTER:

Fever

Autonomic instability

Leukocytosis

Tremor

Elevated CPK/Encephalopathy

Rigidity of muscles

Cause: Too much D2 blockade. Haloperidol, chlorpromazine, withdrawal from L-Dopa.

Phenothiazide Tricyclic

MECH: Blocks postsynaptic mesolimbic dopaminergic receptors in the brain.

USE: Tmnt. of positive symptoms (hallucinations, delusions). Little effect on neg. sympt.

AE: Less sedation, less hypotension, fewer anticholinergic effects, more EPS effects. Also sexual dysfunction, hyperprolactinemia, tardive dyskinesia (facial tics -- treat with tetrabenazine), neuroleptic malignant syndrome (NMS).

Phenothiazide Tricyclic

MECH: Blocks postsynaptic mesolimbic dopaminergic receptors in the brain.

USE: Tmnt. of positive symptoms (hallucinations, delusions). Little effect on neg. sympt.

AE: Less sedation, postural hypotension, anticholinergic effects, less EPS effects. Also sexual dysfunction, hyperprolactinemia, tardive dyskinesia (facial tics -- treat with tetrabenazine), neuroleptic malignant syndrome (NMS).

Phenothiazide Tricyclic

MECH: Blocks postsynaptic mesolimbic dopaminergic receptors in the brain.

USE: Tmnt. of positive symptoms (hallucinations, delusions). Little effect on neg. sympt.

AE: Sedation, postural hypotension, anticholinergic effects, wt. gain. Also sexual dysfunction, hyperprolactinemia, tardive dyskinesia (facial tics -- treat with tetrabenazine), neuroleptic malignant syndrome (NMS).

Phenothiazide Tricyclic

MECH: Blocks postsynaptic mesolimbic dopaminergic receptors in the brain.

USE: Tmnt. of positive symptoms (hallucinations, delusions). Little effect on neg. sympt.

AE: Sedation, postural hypotension, anticholinergic effects, wt. gain. Also sexual dysfunction, hyperprolactinemia, tardive dyskinesia (facial tics -- treat with tetrabenazine), neuroleptic malignant syndrome (NMS).

Butyrophenone.

MECH: Blocks postsynaptic mesolimbic dopaminergic D₁ and D₂ receptors in the brain.

USE: Schizophrenia--chemical straight jacket

AE: AE: Less sedation, less hypotension, fewer anticholinergic effects, more EPS effects. Also sexual dysfunction, hyperprolactinemia, tardive dyskinesia (facial tics -- treat with tetrabenazine), neuroleptic malignant syndrome (NMS).

2nd Generation tricyclic antipsychotic

MECH: Weak antagonism of D₁, D₂, D₃, and D₅ dopamine receptor subtypes, but shows high affinity for D₄; in addition, it blocks the serotonin (5HT₂), alpha-adrenergic, histamine H₁, and cholinergic receptors.

USE: Treatment resistant psychoses, decreases suicide risk. NO EPS; NO Tardive dyskinesia; akathesia (restlessness) rare. ONLY one indicated for pregnancy.

AE: Agranulocytosis, seizure risk, weight gain, diabetes, hyperlipidemia, GI hypomotility, myocarditis.

2nd Generation tricyclic antipsychotic

MECH: Potent antagonism of serotonin 5-HT_2A and 5-HT_2C, dopamine D_1-4, histamine H₁ and alpha₁-adrenergic receptors.

USE: Treatment resistant psychoses, decreases suicide risk. NO EPS; NO Tardive dyskinesia; akathesia (restlessness) rare. NO granulocytosis. Effective against positive sympt. and some efficacy against neg. sympt.

AE: Weight gain, diabetes, hyperlipidemia, somnolence/dizziness, incr. serum transaminases, hypotension, constipation, EPS, hyperprolactinemia, akathesia.

2nd Generation tricyclic antipsychotic

MECH: Combination of dopamine type 2 (D₂) and serotonin type 2 (5-HT₂) antagonism.

USE: Treatment resistant psychoses, decreases suicide risk. NO EPS; NO Tardive dyskinesia; akathesia (restlessness) rare. NO granulocytosis. Effective against positive sympt. and some efficacy against neg. sympt.

AE: Weight gain, hyperglycemia, postural hypotension, constipation, somnolence, dizziness.

Non-tricyclic 2nd gen. antipsychotic

MECH: Mixed serotonin-dopamine antagonist activity that binds to 5-HT₂-receptors in the CNS and in the periphery with a very high affinity; binds to dopamine-D₂ receptors with less affinity.

USE: Effective against positive and (less so) negative symptoms. Fewer metabolic complications.

AE: Postural hypotension, constipation, dizziness, insomnia, hyperprolactinemia, wt. gain, hyperglycemia, EPS (>6mg/day).

Non-tricyclic 2nd gen. antipsychotic

MECH: Mixed serotonin-dopamine antagonist activity that binds to 5-HT₂-receptors in the CNS and in the periphery with a very high affinity; binds to dopamine-D₂ receptors with less affinity.

USE: Effective against positive and (less so) negative symptoms. Fewer metabolic complications.

AE: Mild to moderate somnolence, cardiac arrythmias (QT prolongation), EPS, fewer metabolic effects.

Non-tricyclic 2nd gen. antipsychotic -- Active metabolite of risperidone after P450 metabolism

MECH: Mixed serotonin-dopamine antagonist activity that binds to 5-HT₂-receptors in the CNS and in the periphery with a very high affinity; binds to dopamine-D₂ receptors with less affinity.

USE: Effective against positive and (less so) negative symptoms. Fewer metabolic complications.

AE: Mild to moderate somnolence, cardiac arrythmias (QT prolongation), EPS, fewer metabolic effects.