Discussion: Anti-Psychotics in Depression, Seizures, and Psychosis
Major Differences Between Atypical and Typical Antipsychotics
First-generation antipsychotics (FGAs), also called typical anti-psychotics, and second-generation antipsychotics (SGAs), known as atypical anti-psychotics, differ significantly in their mechanisms and side effect profiles. FGAs primarily block dopamine D2 receptors in the central nervous system (CNS) (Leucht et al., 2021). This strong dopamine blockade effectively reduces positive psychotic symptoms like hallucinations and delusions but often results in extrapyramidal symptoms (EPS), such as dystonia, parkinsonism, akathisia, and tardive dyskinesia. These side effects can be debilitating and limit long-term use.
In contrast, SGAs block both dopamine D2 receptors and serotonin 5-HT2 receptors (Leucht et al., 2021). This dual mechanism reduces the likelihood of EPS, making SGAs more tolerable for many patients. However, SGAs carry a higher risk of metabolic side effects, including diabetes, weight gain, and dyslipidemia, which could increase the risk of cardiovascular disease (Fabrazzo et al., 2022). Despite these risks, SGAs are generally favored due to their broader efficacy, including improvements in both positive and negative indications of psychosis, as well as cognitive function? (Rosenthal & Burchum, 2020, p. 203).
Recommended Treatment and Rationale
For KN, a 26-year-old male newly diagnosed with psychosis and without comorbidities, risperidone is a suitable...
Risperidone is an SGA with proven efficacy in managing both positive indications, such as hallucinations and delusions, and negative symptoms, including social withdrawal and lack of
motivation (Rosenthal & Burchum, 2020, p. 211). Though not without concerns, its side effect profile is manageable with appropriate monitoring.
Alternatively, olanzapine may be considered for its strong efficacy in symptom control. However, it carries a higher risk of significant weight gain and metabolic disturbances, essential considerations for...
…serum levels above this range and requires immediate
intervention (Rosenthal & Burchum, 2020, p. 231).
Baseline and regular monitoring of serum lithium levels, renal function tests (e.g., creatinine, blood urea nitrogen), and thyroid function tests are mandatory. Patients should also be educated on maintaining consistent hydration and avoiding medications like nonsteroidal anti-inflammatory drugs (NSAIDs), which can increase lithium levels. Regular follow-ups are essential to adjust dosages and prevent complications?.
Conclusion
The choice of antipsychotic therapy and subsequent monitoring should balance efficacy with the patients safety and quality of life. SGAs like risperidone provide effective symptom management with fewer motor side effects, making them a preferred option for younger patients. Lithium offers an alternative in cases where SGAs are insufficient, albeit with stricter monitoring requirements to mitigate its risks. A structured approach to monitoring ensures that both medications benefits outweigh their risks,…
