Antipsychotics

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All antipsychotic medications have potential side-effects.

They vary from person to person, but can include:. Talk to your doctor. Changing medicine can take time and will need careful guidance and observation from a health professional. Within three months of the change in his medication, Jock took over his own life. If this happens, your doctor may suggest clozapine, a drug which is very effective but comes with a greater risk of side effects. Antipsychotic medications are designed to reduce and prevent the return of psychotic symptoms, including hallucinations, delusions and disordered thinking. They may not affect the other symptoms of your illness, so you may need to get other treatments for these symptoms.

Antipsychotic medication is considered the main treatment for psychosis, but other treatments are available.

Psychosis - Treatment - NHS

So you may be prescribed anti-anxiety medications, anti-depressants or mood stabilisers along with your antipsychotics. This is relatively common — the medications are often used together. This SANE factsheet is currently being reviewed by industry professionals, carers and people with lived experience of psychosis. Australian Bureau of Statistics, Accessed 17 March SANE Forums.

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Antipsychotic medication. Listen to this page.

Antipsychotic medication facts

Antipsychotic medications are common: in , nearly , Australians had at least one prescription filled for antipsychotic medication. If your doctor suggests medication, ask: how long will it take to start working? This can be a challenge if alcohol is a big part of your social life. Talk to your doctor about what is a safe amount to drink and whether other treatment options are available. Medication by mouth usually means a tablet, once or twice a day. Medication by depot is when you take your medication as a regular injection.

The depot sits under your skin and releases the medication over two or four weeks, so you get a steady dose. No antipsychotic medications are approved by the FDA for the treatment of disruptive behavior disorders. In a study of children with fairly severe disruptive behavior disorder symptoms, those who received risperidone showed approximately twice the rate of improvement in conduct problem behaviors over six to 10 weeks of treatment compared with those who took a placebo.

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About 27 percent of children who continued taking risperidone for six months had a relapse compared with 42 percent of the children who did not receive medication, but the degree of improvement decreased in both groups. In a study of teenagers with disruptive behavior symptoms requiring hospitalization, risperidone improved their overall assessments, with 21 percent assessed as "markedly or severely disturbed" compared with 84 percent taking a placebo. Quetiapine Seroquel has not been found to be effective in improving aggressive behavior associated with conduct disorder.

In the only available study, quetiapine was no better than a placebo at reducing aggression and hyperactivity in teenagers with conduct disorder and moderate-to-severe aggressive behavior. One of nine of the children 11 percent stopped taking the medication due to akathisia, a side effect that makes people feel as if they can't sit still. Quetiapine was superior to a placebo on global measures of symptom improvement and quality of life. Atypical antipsychotics can cause significant side effects, which limit their overall usefulness. See Table 2, below.

In addition, people with schizophrenia and bipolar disorder are highly prone to stopping their medicine because of the nature of their disease. They might not understand that they have a psychiatric disorder, fail to accept that they benefit from medication, forget to take it, or quit taking it when the most serious symptoms ease. One serious side effect of atypical antipsychotics is movement-related extrapyramidal -uncontrollable tics and tremors that resemble Parkinson's disease.

Extrapyramidal side effects generally go away when the drug is discontinued or the dosage is lowered. But a specific movement disorder called tardive dyskinesia can develop with more prolonged use and might persist even after a patient stops taking the antipsychotic. Atypical antipsychotic drugs also cause other serious side effects, including an increased risk of type 2 diabetes, substantial weight gain, and elevated cholesterol and triglyceride levels.

In addition, they have been found to increase the risk of premature death, primarily due to strokes, in older adults with dementia. Overall, 80 to 90 percent of adults who take an antipsychotic of any kind will have at least one side effect; most will have more than one. Of those who experience side effects:. Due to the limited studies of children and teenagers, the adverse effects of atypical antipsychotics are not fully known.

The side-effect profile varies by drug, so when considering one for your child, the risks of each specific drug should be considered against the potential benefit.

References

The following sections are an overview of the side effects found in studies involving children and teens. Weight gain is perhaps the most common side effect associated with atypical antipsychotics taken by children and teenagers.

What are Antipsychotics?

Risperidone Risperdal given at low doses, for example, leads to an average weight gain of about 4 pounds in children with pervasive development disorders or disruptive behavior disorders compared with those given a placebo. It is not yet clear whether this weight gain stabilizes or continues to increase over the longterm. Current evidence suggests continued weight gain, with estimates of 4 to 12 pounds in one year and up to 18 pounds after two years.

Weight gain is also the most problematic side effect with aripiprazole Abilify. In one study, 15 percent of children taking it experienced a notable weight gain at least 7 percent above starting weight over eight weeks. In another study, 32 percent of children experienced a notable weight gain while on aripiprazole.

In both studies, children taking a placebo experienced negligible weight gain. Whether the weight gain associated with aripiprazole continues over the long-term is unclear because no long-term studies of weight gain with continued treatment are available. Olanzapine Zyprexa is also associated with weight gain, with children gaining 7. One study found that two-thirds of children gained at least 7 percent more than their starting weight.

As in the case with aripiprazole Abilify , studies of weight gain in children who continue to take olanzapine for a longer term are not available. Quetiapine also causes weight gain. For example, in a study in children with a depressed episode of bipolar disorder, those who received quetiapine gained about 3 pounds more than those who received a placebo.

Some atypical antipsychotic drugs can increase total cholesterol LDL and triglycerides. In addition, those drugs-with the possible exception of aripiprazole Abilify -can increase blood sugar, or other markers of diabetes, in some children, or worsen blood sugar control for those with pre-existing diabetes. It is not possible to say how much of an increased risk the drugs add, or if one drug is worse than another for children.

A Call for Caution on Antipsychotic Drugs

Based on published studies, olanzapine Zyprexa might cause a bigger increase in cholesterol levels in children than in adults. While heart-rhythm patterns EKGs were normal, one study showed a temporary increase in heart rate with risperidone during the first two weeks of treatment. The participants' heart rates returned to normal after two weeks of treatment. In studies of children taking atypical antipsychotics, there were a few who exhibited suicidal behavior, but it is not possible to tell if this represents an increase or decrease in the risk of suicidal behavior, or no impact at all.

Psychoactive medications, such as certain antidepressants, have been found to increase this risk in adolescents.

Psychopharmacology - Antipsychotics Pharmacology

Because aripiprazole Abilify and quetiapine Seroquel share some of the same neurotransmitter activity in the brain as these antidepressants, the drugs carry a serious warning that they might increase the risk of suicidal thinking and behavior, even though the evidence is not clear. In adults with schizophrenia, clozapine Clozaril, Fazaclo ODT is the only atypical antipsychotic drug that has been found to reduce the risk of suicide or suicidal behavior. This has not been studied in children. Studies of risperidone Risperdal have found low rates of other side effects, but this might be due to the low doses used, and the short follow up.

Abnormal limb and body movements extrapyramidal symptoms , were infrequent in short-term trials, but they were reported more often than with patients taking a placebo. Risperidone is known to cause increased levels of the hormone prolactin, which helps in the production of breast milk after pregnancy. In non-pregnant women and men, increased prolactin can result in enlarged breasts and problems with sexual function. Studies of children found that risperidone elevated prolactin levels, but none showed signs or symptoms such as breast enlargement.

It's not clear if, over time, prolactin levels stay elevated or return to normal. Other side effects seen more frequently with aripiprazole Abilify than a placebo include sleepiness, drooling, tremors, nausea, or vomiting. Abnormal movements of the arms, legs, or body were also seen more often in children taking aripiprazole.

Further study is needed to determine if these side effects resolve, remain constant, or worsen over time with continued treatment. In a study of the use of quetiapine Seroquel in the treatment of teenagers with conduct disorder, 11 percent of those taking the medication stopped due to akathisia, a condition where a person feels quite restless, as though they can't sit still. Otherwise, the drug was well-tolerated. Other side effects reported by children taking olanzapine included sedation and increased appetite.

Overall, side effects were reported more often with olanzapine Zyprexa than with either quetiapine Seroquel or risperidone Risperdal. Rigidity was more frequently present in patients treated with olanzapine compared with quetiapine, and fatigue was more frequent with olanzapine compared with risperidone. But more patients taking risperidone reported a movement-related side effect compared with those taking olanzapine.

Because of the small body of evidence about the use of atypical antipsychotics by children and teenagers, it's difficult to determine their short term effectiveness and safety. And nothing is known about their long-term safety and efficacy because the studies involving younger people have been relatively small and short in duration. So we are unable choose a Best Buy atypical antipsychotic for use by children and teenagers with schizophrenia, bipolar disorder, pervasive developmental disorders, or disruptive behavior disorders.

Instead, our medical advisers recommend that parents carefully weigh the risks and benefits. A comprehensive treatment plan for children with these disorders should include cognitive behavioral therapy, parent-management training and specialized educational programs, along with any potential drug therapy.

Deciding whether to use one of these medications at all, and if so, which one, should be done in conjunction with your child's doctor and should be based on several important considerations. For example, what are your child's most significant, distressing, or impairing symptoms? Are these symptoms that antipsychotic drugs have been found to relieve?

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