What is included in education for a patient taking antipsychotics

Antipsychotic medications can reduce or relieve symptoms of psychosis, such as delusions (false beliefs) and hallucinations (seeing or hearing something that is not there). Formerly known as major tranquilizers and neuroleptics, antipsychotic medications are the main class of drugs used to treat people with schizophrenia. They are also used to treat people with psychosis that occurs in bipolar disorder, depression and Alzheimer’s disease. Other uses of antipsychotics include stabilizing moods in bipolar disorder, reducing anxiety in anxiety disorders and reducing tics in Tourette syndrome.

Antipsychotic medications can help to calm and clear confusion in a person with acute psychosis within hours or days, but they can take up to four or six weeks to reach their full effect. These medications can help to control symptoms, but they do not cure the underlying condition. When taken over a longer term, antipsychotics can help to prevent further episodes of psychosis.

While antipsychotic medications can help some people with psychosis and mood disorders, these drugs can have serious side-effects. The aim of medication treatment is to reduce and control symptoms while keeping side-effects at a minimum.

Combining antipsychotic medication with other therapy and support can help people to manage symptoms and improve quality of life. Family therapy, peer support, school and job counselling, and housing and employment supports can all be helpful. Some therapists now offer cognitive-behavioural therapy to help people cope with voices and other auditory hallucinations.

Taking care of your physical health is especially important if you take antipsychotic medication. Both schizophrenia and the medications used to treat it can increase the risk of diabetes and other serious health problems. Getting regular checkups and medical care can help you to have good physical health. Eating a nutritious diet, exercising regularly and getting enough sleep can also help you to get and stay well.

Do I need this treatment?

Psychosis; can be dangerous, frightening, isolating and disabling. Symptoms of psychosis, such as delusions and hallucinations, may come on gradually and build up over time, or they may come on rapidly. People experiencing psychosis may not be aware that the experiences they are having are not normal. To them, what is happening in their minds is very real.

Recognizing and treating psychosis in the early stages greatly improves a person’s ability to recover and to lead a satisfying and rewarding life. Family, friends, colleagues and health providers play an important role in recognizing the signs of psychosis and in encouraging the person to get treatment. However, the symptoms of psychosis can sometimes lead to a breakdown in the person’s relationships with the people who might be most able to help him or her get treatment. Family members and others who support a person with psychosis may wish to seek support themselves, for example, from a family support group.

People with anxiety and mood disorders may benefit from taking antipsychotics in addition to antidepressants or mood stabilizers. When used in this way, antipsychotics may help to control symptoms such as irritable or depressed mood, disorganized thinking, and trouble concentrating and remembering.

What does Antipsychotic Medications do?

Psychosis is believed to be caused, at least in part, by overactivity of a brain chemical called dopamine, and antipsychotics are thought to work by blocking this dopamine effect. This blocking helps to make the symptoms of psychosis—such as voices and delusions—less commanding and preoccupying, but it does not always make them go away completely. People may still hear voices and have delusions, but they are more able to recognize what isn’t real and to focus on other things, such as work, school or family.

Side effects of Antipsychotic Medications

Antipsychotic medication can cause unpleasant side-effects, especially when the symptoms are severe and a higher dose of medication is used. Side-effects should become mild or at least tolerable when the dose is reduced and as your body adjusts to the presence of the drug.

Most side-effects will go away when you stop taking the drug. There is a risk, however, of a condition that causes people to make involuntary movements, known as tardive dyskinesia, which can be permanent.

Some people accept the side-effects as a trade-off for the relief these drugs can bring. Others find the side-effects distressing and may choose not to take the medication.

Check the information given to you by your doctor or pharmacist to find out the specific side-effects of any drug you have been prescribed. If you are troubled by any of these effects, it is best to continue to take your medication as prescribed and let your doctor know as soon as possible. Your doctor may:

• adjust your dose
• prescribe other medications to help control side-effects
• change your medication.

Side-effects of antipsychotics

• Movement effects: Tremors, muscle stiffness and tics can occur. The higher the dose, the more severe these effects. The risk of these effects may be lower with the second generation medications than with the older drugs. Other drugs (e.g., benztropine [Cogentin]) can be used to control the movement effects.
• Dizziness: Feelings of dizziness may occur, especially when getting up from a sitting or lying position.
• Weight gain: Some of the second generation drugs are thought to affect people’s sense of having had enough to eat. They can also be sedating. These two effects can result in weight gain, which can increase a person’s risk of diabetes and heart disease.
• Diabetes: Schizophrenia is a risk factor for diabetes. Antipsychotic drugs can increase this risk.
• Agitation and sedation: Some people feel “wired” and unable to stop moving when taking antipsychotics. This effect may be mistaken for a worsening of illness rather than a side-effect of the medication. These same drugs can also have the opposite effect, making people feel tired. Some people may feel either wired or tired, and some may feel both at the same time.
• Tardive dyskinesia: For every year that a person takes antipsychotic medication, there is a five per cent chance of developing tardive dyskinesia (TD), a condition that causes people to have repetitive involuntary movements. The risk of TD is highest with the first generation antipsychotics, although it can occur with the second generation drugs. TD can worsen when you stop taking medication and can be permanent .
• Neuroleptic malignant syndrome: This rare but serious complication is usually associated with the use of high doses of typical antipsychotics early in treatment. Signs include fever, muscle stiffness and delirium.

Side-effects vary depending on the type of medication. More information on side-effects is included with each type of antipsychotic.

Controlling the side-effects of antipsychotics

You can help to control possible side-effects on your own by:

• getting regular exercise and eating a low-fat, low-sugar, high-fibre diet (e.g., bran, fruits and vegetables) to reduce the risk of diabetes and help prevent weight gain and constipation
• using sugarless candy or gum, drinking water, and brushing your teeth regularly to increase salivation and ease dry mouth
• getting up slowly from a sitting or lying position to help prevent dizziness.

Types of Antipsychotic Medications

NOTE: medications are referred to in two ways: by their generic name and by their brand or trade names. Brand names available in Canada appear in brackets.

Antipsychotic medications are sometimes used to calm older adults with psychosis related to dementia. However, use of antipsychotics by older adults has been associated with an increased risk of stroke. Other ways of calming the person should always be tried first, and when antipsychotics are needed, they should only be used until symptoms are relieved.

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