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Psychosis and Antipsychotic Drugs: Overview01:28

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The term "psychosis" refers to a spectrum of mental disorders characterized by abnormal thoughts, perceptions, and behaviors. It can manifest as mood disorders, dementia, delirium with psychotic features, substance-induced psychosis with psychotic features, brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophrenia. Among all these disorders, schizophrenia is the most common psychotic disorder, affecting 1% of the worldwide population. Psychotic...
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Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
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Antipsychotic drugs are classified into first-generation (typical) drugs including phenothiazines; and second-generation (atypical) drugs. Chlorpromazine hydrochloride (Thorazine), a phenothiazine derivative, broadly impacts the central, autonomic, and endocrine systems. This drug, along with typical agents like haloperidol (Haldol), primarily works by antagonizing D2 receptors, thus reducing dopaminergic neurotransmission. However, typical antipsychotics can cause side effects such as sedation...
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Antipsychotic drugs primarily block dopamine and serotonin receptors and cholinergic, adrenergic, and histaminergic receptors, thereby reducing hallucinations and delusions in conditions like schizophrenia. However, they can trigger unwanted extrapyramidal effects such as dystonias, Parkinson-like symptoms, and tardive dyskinesia.
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Antipsychotics in Perspective: Past, Present, and Future.

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For decades, psychotropic medication use in nursing homes has been controversial. Despite reductions in antipsychotics, broader issues with other psychotropics persist, requiring new approaches.

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Area of Science:

  • Geriatric Pharmacy
  • Psychopharmacology
  • Long-Term Care

Background:

  • Nursing home residents frequently experience behavioral, mood, and cognitive issues.
  • Psychotropic medication use in this population has a long history of controversy and inconsistent application.
  • While antipsychotic use has decreased, concerns regarding other psychotropics remain significant.

Purpose of the Study:

  • To examine the historical context of psychotropic medication use in nursing homes.
  • To address the ongoing controversies and challenges associated with psychotropic prescribing.
  • To propose future directions for improving medication management in long-term care.

Main Methods:

  • Historical review of psychotropic medication use in nursing homes.
  • Analysis of controversies, government actions, and professional discussions.
  • Examination of various perspectives on psychotropic prescribing practices.

Main Results:

  • Significant historical debate surrounds the use of psychotropics for behavior, mood, and cognition in nursing home residents.
  • Antipsychotic use has declined, but the use of other psychotropic classes remains a concern.
  • Current efforts to reduce medication use may require re-evaluation and broader considerations.

Conclusions:

  • Further improvement necessitates reconsidering current beliefs and approaches to psychotropic prescribing.
  • A pause and renewed meaningful discussion are essential for addressing complex issues.
  • This series will explore history, perspectives, and future recommendations for psychotropic management.