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Treatment of psychotic disorders

Treatment of psychotic disorders. (schizophrenia & other related disorders) 1- Psychopharmacology: - Antipsychotic medications (Neuroleptics ) Prescribed for their efficacy in decreasing psychotic symptoms . Do not cure schizophrenia but used to manage the symptoms of the disease.

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Treatment of psychotic disorders

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  1. Treatment of psychotic disorders (schizophrenia & other related disorders) 1- Psychopharmacology: - Antipsychotic medications(Neuroleptics) • Prescribed for their efficacy in decreasingpsychotic symptoms. • Do not cure schizophrenia but used to manage the symptoms of the disease Psychiatric and Mental Health Nursing

  2. Types of antipsychotics: 1. Older antipsychotic medications: dopamine antagonists, target positive signs of schizophrenia, as delusions, hallucinations & disturbed behavior. • have no observable effect on the negative signs. 2. Newer or atypical antipsychotic medications are both (dopamine & serotonin antagonists) . - Diminish positive symptoms; also lessen the negative signs of lack of volition and motivation, social withdrawal, and blunt affect. Psychiatric and Mental Health Nursing

  3. MAINTENANCE THERAPY: • Antipsychotics injection available for maintenance therapy: • Fluphenazine decanoate (modecate), haloperidol (Haldol), Zuclopenthixol (Clopixol) . • Absorbed slowly over time. • The effects: 2 – 4 weeks, • Eliminating the need for daily oral antipsychotic medication. Psychiatric and Mental Health Nursing

  4. MAINTENANCE THERAPY ….cont. • It may take several weeks of oral therapy to reach a stable dosing level before transition to maintenance therapy. • Not suitable for the management of acute episodes of psychosis. • Very useful for clients requiring supervised medication compliance over an extended period. Psychiatric and Mental Health Nursing

  5. *Typical ANTIPSYCHOTICS • Chlorpromazine (Largctile) • Fluphenazine (modicate) • Thioridazine (Mellaril) • Trifluoperazine (Trifluzine) • Haloperidol (Haldol) • Pimozide (Orap) *Atypical ANTIPSYCHOTICS • Clozapine (liponex) • Risperidone (Risperdal) • Olanzapine (Zyprexa) • Quetiapine (Seroquel) • Aripiprazole (Abilify) Psychiatric and Mental Health Nursing

  6. ANTIPSYCHOTIC DRUGS, DAILY DOSAGES, AND SIDE EFFECTSKey: + = Very low, ++ = Low, +++ = Moderate, ++++ = High, +++++ = Very high Psychiatric and Mental Health Nursing

  7. Side Effects of antipsychotics: (1) Orthostatic Hypotension: • Dizziness on standing or walking, managed byrisingfrom bed, moving slowly, and using assistive devices when necessary . (2) Anticholinergic Effects: • Dry mouth and nose, blurred vision, constipation, urine retention. Managed symptomatically. Psychiatric and Mental Health Nursing

  8. Side Effects of antipsychotics: ..cont. (3) Extra pyramidal Adverse Effects (EPS): a- Short-term side effects include: • - Akathisia: “restless leg syndrome”. find it difficult to sit or sleep. activities are interrupted by the urge to move the limb or to change positions. • - Dystonias, dyskinesias: grimacing, intermittent spasms, oculogyric crises, head-neck stiffness, twitches. • - Parkinsonian effects: muscle stiffness, cog wheel rigidity, shuffling gait, stooped posture, drooling Psychiatric and Mental Health Nursing

  9. Side Effects of antipsychotics: ..cont. b- Long-Term side effects (EPS): - Tardive dyskinesia: usually occurring after 6 months of treatment: abnormal, involuntary, irregular movements of the muscles of the head ( lip smacking, tongue protrusion, chewing, blinking, grimacing) and choreform- (rapid jerky) movements of limbs, and trunk. - Involuntary movements are embarrassing for clients causing them to become more sociallyisolated. -Tardive dyskinesia is worse irreversible, but decreasing/discontinuing medication can arrest progression. Psychiatric and Mental Health Nursing

  10. Side Effects of antipsychotics: ..cont. • Extra pyramidal Adverse Effects (EPS) can managed by using medications as: 1- Anticholinergics :Trihexyphenidyl (Artane), Benztropine (Cogentin), Biperiden (Akineton) 2- Antihistaminics: Promethazine (phenergan), Chlorophenramine (Ahiston) 3- Benzodiazpines: Diazepam (Valium), Lorazepam (loracare) Psychiatric and Mental Health Nursing

  11. Side Effects of antipsychotics: ..cont. (4) Seizures: • Rare side effect mainly occur with high doses of clozapine “liponex”. (5)Neuroleptic malignant syndrome (NMS): • Serious and fatal condition. • Characterized by muscle rigidity, high fever, increased muscle enzymes as (CPK), and leukocytosis . Psychiatric and Mental Health Nursing

  12. Side Effects of antipsychotics: ..cont. (6) Agranulocytosis: “granulopenia”  (lowered white blood cell count) • Clozapine (liponex) has potentially fatal side effect. • Develops suddenly and characterized by fever, malaise, sore throat. • Drug must stopped immediately. • Clients taking “liponex” must have weekly white blood cell counts. Psychiatric and Mental Health Nursing

  13. Treatment of psychotic disorders.. Cont. 2- Hospitalization: -Patients may receive treatment in hospital depends on severity of symptoms & risk of harm to self & others. -Community daily care and nocturnal care are recommended for less severe cases. Psychiatric and Mental Health Nursing

  14. Treatment of psychotic disorders.. Cont. 3- Cognitive behavioral therapy CBT • Albert Ellis theory (1913 – 2007) American psychologist, 1955 developed rational emotive behavior (REBT) • Suitable in the later stages of recovery • Individuals can positively influence their symptoms by changing behavior and thinking. • Approach to therapy replacedestructive ways of the pastwithconstructive approaches for the future. Psychiatric and Mental Health Nursing

  15. Treatment of psychotic disorders.. Cont. 4- Group Therapy: • Social contact & relationships with other people. • Groups focus on topics of concern such as medication management, community supports, social training skills. • Each patient is talking about his experience with the disease and listens to the experiences of others Psychiatric and Mental Health Nursing

  16. Treatment of psychotic disorders.. Cont. 5- Family Therapy: • Diminishnegative effects of schizophrenia and reduce the relapse rate. • Make family members part of the treatment team. • helps to cope with many difficulties and dealing with stigma of mental illness 6- Occupational therapy: • Help psychotic patient to restore maximum level of functioning: through Vocational training , ADL instruction and social skills education. Psychiatric and Mental Health Nursing

  17. Treatment of psychotic disorders.. Cont. 7- Electro Convulsive therapy (ECT): “Electroshock therapy”, “Shock treatment” • Indicatedfor catatonic patients or limitedresponse to antipsychotic drugs. • Used as a last line of intervention for Other disorders e.g. major depressive disorder and mania. • Need informed consent Psychiatric and Mental Health Nursing

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