Chlorprothixene is an atypical antipsychotic. It manifests itself with such symptoms. Types of atypical antipsychotics

psychotropic drug, the purpose of which is the treatment of psychotic disorders, is called antipsychotic (also antipsychotic or antipsychotic). What is it and how does it work? Let's figure it out.

Antipsychotic. What it is? History and characteristics

Antipsychotics in medicine appeared relatively recently. Prior to their discovery, drugs with vegetable origin(e.g. henbane, belladonna, opiates), intravenous administration calcium, bromides, and narcotic sleep.

In the early 50s of the 20th century, they began to use for these purposes antihistamines or lithium salts.

One of the very first antipsychotics was chlorpromazine (or chlorpromazine), which until then was considered common. antihistamine. It has been widely used since 1953, mainly as or as antipsychotics (for schizophrenia).

The next neuroleptic was the alkaloid reserpine, but soon gave way to other, more effective drugs, since it had practically no effect.

In early 1958, other first-generation antipsychotics appeared: trifluoperazine (triftazine), haloperidol, thioproperazine, and others.

The term "neuroleptic" was proposed in 1967 (when the classification was created psychotropic drugs first generation) and he treated drugs not only with antipsychotic effects, but also capable of causing neurological disorders(akatasia, neuroleptic parkinsonism, various dystonic reactions and others). Typically, these disorders were caused by substances such as chlorpromazine, haloperidol and triftazin. Moreover, their treatment is almost always accompanied by unpleasant side effects: depression, anxiety, severe fear, emotional indifference.

Previously, antipsychotics could also be called "great tranquilizers", so antipsychotics and tranquilizers are one and the same. Why? Because they also cause pronounced sedative, hypnotic and tranquilizing-anti-anxiety effects, as well as a rather specific state of indifference (ataraxia). Now this name in relation to neuroleptics is not applied.

All antipsychotics can be divided into typical and atypical. We have partially described typical antipsychotics, now we will consider an atypical antipsychotic. a group of softer drugs. They do not act as strongly on the body as typical ones. They belong to the new generation of neuroleptics. The advantage of atypical antipsychotics is that they have less effect on dopamine receptors.

Antipsychotics: indications

All antipsychotics have one main property - an effective effect on productive symptoms (hallucinations, delusions, pseudohallucinations, illusions, behavioral disorders, mania, aggressiveness and arousal). In addition, antipsychotics (mostly atypical) may be prescribed to treat depressive or deficient symptoms (autism, emotional flattening, desocialization, etc.). However, their effectiveness in relation to the treatment of deficient symptoms is under big question. Experts suggest that antipsychotics can only eliminate secondary symptoms.

Atypical neuroleptics, whose mechanism of action is weaker than typical ones, are also used to treat bipolar disorder.

The American Psychiatric Association prohibits the use of antipsychotics to treat the psychological and behavioral symptoms of dementia. Also, they should not be used for insomnia.

It is unacceptable to be treated with two or more antipsychotic drugs at the same time. And remember that neuroleptics are used to treat serious illnesses, it is not recommended to take them just like that.

Main effects and mechanisms of action

Modern antipsychotics have one general mechanism antipsychotic action, because they can reduce the transmission of nerve impulses only in those brain systems in which dopamine transmits impulses. Let's take a closer look at these systems and the effect of antipsychotics on them.

mesolimbic pathway. A decrease in transmission in this pathway occurs when taking any antipsychotic drug, since it means the removal of productive symptoms (for example, hallucinations, delusions, etc.)
mesocortical pathway. Here, a decrease in the transmission of impulses leads to the manifestation of symptoms of schizophrenia (there are such negative disorders as apathy, desocialization, poverty of speech, smoothing of affect, anhedonia) and cognitive impairment (attention deficit, impaired memory function, etc.). The use of typical antipsychotics, especially long-term use, leads to increased negative disorders, as well as serious violations brain functions. Cancellation of neuroleptics in this case won't help anything.
Nigrostriatal path. Blockade of dopamine receptors in this case usually leads to side effects typical of antipsychotics (akathisia, parkinsonism, dystonia, salivation, dyskinesia, trismus of the jaws, etc.). These side effects observed in 60% of cases.
Tuberoinfundibular pathway (transmission of impulses between the limbic system and the pituitary gland). Blocking the receptors leads to an increase in the hormone prolactin. Against this background, there is great amount other side effects such as gynecomastia, galactorrhea, sexual dysfunction, infertility pathology, and even a pituitary tumor.

Typical neuroleptics have a greater effect on dopamine receptors; atypical ones affect serotonin with other neurotransmitters (substances that transmit nerve impulses). Because of this, atypical antipsychotics are less likely to cause hyperprolactinemia, neuroleptic depression, as well as neurocognitive deficits and negative symptoms.

Signs of blockade of α 1 -adrenergic receptors are a decrease blood pressure, orthostatic hypotension, the development of dizziness, the appearance of drowsiness.

With blockade H 1 -histamine receptors hypotension appears, an increase in the need for carbohydrates and an increase in body weight, as well as sedation.

If blockade of acetylcholine receptors occurs, the following appear side effects: constipation, dry mouth, tachycardia, increased intraocular pressure and disturbances of accommodation. Confusion and drowsiness may also occur.

Western researchers have proven that there is a link between antipsychotics (new antipsychotics or old ones, typical or atypical, it doesn't matter) and sudden cardiac death.

Also, when treated with antipsychotics, the risk of stroke and myocardial infarction is significantly increased. This is because psychotic drugs affect lipid metabolism. Antipsychotics may also cause diabetes 2nd type. chances of getting serious complications increase with combined treatment with typical and atypical antipsychotics.

Typical neuroleptics can provoke epileptic seizures, as they lower the threshold for convulsive readiness.

Most antipsychotics (mainly phenothiazine antipsychotics) have a large hepatotoxic effect, and can even cause the development of cholestatic jaundice.

Treatment with antipsychotics in the elderly can increase the risk of pneumonia by 60%.

The cognitive effect of neuroleptics

Conducted open studies have shown that atypical antipsychotics are slightly more effective than typical ones in the treatment of neurocognitive insufficiency. However, there is no convincing evidence of any effect on neurocognitive impairment. Atypical neuroleptics, whose mechanism of action is slightly different from the typical ones, are often tested.

In one of clinical research physicians compared the effects of risperidone and haloperidol at low doses. During the study, no significant differences were found in the readings. Haloperidol at low doses has also been shown to have a positive effect on neurocognitive performance.

Thus, the question of the impact of first or second generation antipsychotics on the cognitive sphere is still controversial.

Classification of antipsychotics

It has already been mentioned above that antipsychotics are divided into typical and atypical.

Typical antipsychotics include:

Sedative antipsychotics (having an inhibitory effect after use): promazine, levomepromazine, chlorpromazine, alimemazine, chlorprothixene, periciazine and others.
Incisive antipsychotics (have a powerful global antipsychotic effect): fluphenazine, trifluoperazine, thioproperazine, pipothiazine, zuclopenthixol, and haloperidol.
Disinhibiting (have an activating, disinhibitory effect): carbidine, sulpiride and others.

Atypical antipsychotics include substances such as aripiprazole, sertindole, ziprasidone, amisulpride, quetiapine, risperidone, olanzapine, and clozapine.

There is another classification of antipsychotics, according to which they distinguish:

Phenothiazines, as well as other tricyclic derivatives. Among them there are such types:
● neuroleptics with a simple aliphatic bond (levomepromazine, alimemazine, promazine, chlorpromazine), powerfully block acetylcholine receptors and adrenoceptors, have a pronounced sedative effect and can cause extrapyramidal disorders;
● antipsychotics with a piperidine core (thioridazine, pipothiazine, periciazine), which have a moderate antipsychotic effect and mild neudocrine and extrapyramidal side effects;
● Antipsychotics with a piperazine core (fluphenazine, prochlorperazine, perphenazine, thioproperazine, frenolone, trifluoperazine) are able to block dopamine receptors, and also have little effect on acetylcholine and adrenoreceptors.
All thioxanthene derivatives (chlorprothixene, flupentixol, zuclopenthixol), whose action is similar to that of phenothiazines.
Substituted benzamides (tiapride, sultopride, sulpiride, amisulpride), the action of which is also similar to phenothiazine antipsychotics.
All derivatives of butyrophenone (trifluperidol, droperidol, haloperiodol, benperidol).
Dibenzodiazapine and its derivatives (olanzapine, clozapine, quetiapine).
Benzisoxazole and its derivatives (risperidone).
Benzisothiazolylpiperazine and its derivatives (ziprasidone).
Indole and its derivatives (sertindole, dicarbine).
Piperazinylquinolinone (aripiprazole).

Of all the above, it is possible to distinguish available antipsychotics - drugs sold without prescription in pharmacies, and a group of antipsychotics that are sold strictly according to the doctor's prescription.

Interactions of neuroleptics with other drugs

Most often, these symptoms appear when the antipsychotic is withdrawn (this is also called has several varieties: hypersensitivity psychosis, unmasked dyskinesia (or recoil dyskinesia), cholinergic "recoil" syndrome, etc.

To prevent this syndrome, treatment with antipsychotics must be completed gradually, gradually reducing the dose.

When taking antipsychotics in high doses, a side effect such as neuroleptic deficient syndrome is noted. According to anecdotal evidence, this effect occurs in 80% of patients taking typical antipsychotics.

Structural changes in the brain with prolonged use

According to placebo-controlled studies of macaques given normal doses of olanzapine or haloperidol for two years, neuroleptics reduce brain volume and weight by an average of 8-11%. This is due to a decrease in the volume of white and gray matter. Recovery after neuroleptics is impossible.

After the publication of the results, researchers were accused of not testing the effects of antipsychotics on animals before entering the pharmaceutical market, and that they pose a danger to humans.

One of the researchers, Nancy Andreasen, is sure that the decrease in the volume of gray matter and the use of antipsychotics in general negatively affect the human body and lead to atrophy of the prefrontal cortex. On the other hand, she also noted that antipsychotics are important medicine, able to cure many ailments, but they need to be taken only in very small quantities.

In 2010, researchers J. Leo and J. Monkrieff published a review of research based on magnetic resonance imaging of the brain. The study was carried out to compare brain changes patients taking antipsychotics and patients not taking them.

In 14 out of 26 cases (in patients taking antipsychotics), a decrease in brain volume, gray and white matter volume was observed.

Of the 21 cases (in patients who did not take antipsychotics or took them, but in small doses), none showed any changes.

In 2011, the same researcher Nancy Andreasen published the results of a study in which she found changes in brain volume in 211 patients who took enough antipsychotics. for a long time(more than 7 years). At the same time, the larger the dose of drugs, the more significantly the volume of the brain decreased.

Development of new drugs

On the this moment new antipsychotics are being developed that would not affect receptors. One group of researchers claimed that cannabidiol, a component of cannabis, has an antipsychotic effect. So it is possible that soon we will see this substance on the shelves of pharmacies.

Conclusion

We hope no one has any questions left about what a neuroleptic is. What is it, what is its mechanism of action and the consequences of taking it, we discussed above. It remains only to add that whatever the level of medicine in modern world, no substance can be fully explored. And the trick can be expected from anything, and even more so from such complex drugs as antipsychotics.

AT recent times cases of treatment of depression with antipsychotics have become more frequent. Out of ignorance of the dangers of this drug, people make things worse for themselves. Antipsychotics should never be used for any purpose other than their intended use. And what effect these drugs produce on the brain is out of the question.

That is why neuroleptics - drugs available for purchase without prescriptions, should be used with caution (and only if you are 100% sure that you need it), and even better not to use at all without a doctor's prescription.

Antipsychotics - medications suppressing excessive excitation of the central nervous system manifested in psychoses, hallucinations, delusions and other symptoms. Otherwise this group drugs are called antipsychotics. These drugs have a different chemical structure and mechanism of action. How do neuroleptics work?

Antipsychotics significantly slow down the transmission of nerve impulses in the brain. Antipsychotic drugs block dopamine receptors, thereby eliminating the symptoms of mental overexcitation in psychosis and other diseases. Many antipsychotics also have anticholinergic and antihistamine effects.

Appointment and side effects of neuroleptics

What do neuroleptics treat? They resort to treatment with these psychotropic substances for the following pathologies:

Aggressive human behavior life threatening the health of those around you.
hallucinatory delusions with mental illness, drug and alcohol intoxication.
anxiety states, unreasonable fear death, panic attacks.
paranoid disorders.
catatonic excitement.
Psychoses (manic-depressive).
insomnia caused by increased anxiety.
Psychosomatic disorders caused by increased anxiety (irritable bowel syndrome, etc.).
Neuroleptanalgesia during operations.

The side effects of neuroleptics are related to their pharmacological action on sensitivity to neurotransmitters of the nervous system (adrenaline and norepinephrine, dopamine, serotonin, acetylcholine).

Antipsychotics inhibit dopaminergic transmission at several levels in the brain. Therapeutic action aims to block dopamine transmission in the mesolimbic pathway. Stroke suppression nerve impulse in the mesocortical pathway may increase the symptoms of certain diseases (apathy, depression, speech disorder).

AT extrapyramidal system, consisting of the basal nuclei, blocking dopaminergic processes leads to dyskinesia (, i.e., involuntary movements of the body during movement or at rest). Akathisia (motor restlessness, restlessness) is also a consequence of disorders in the stria-pallidar and nigrostriatal system under the action of neuroleptics. When blocking dopamine receptors, the level of prolactin and cholesterol increases, and sleep may be disturbed.

Side effects of neuroleptics:

Drug-induced parkinsonism (in the older generation of neuroleptics), extrapyramidal disorders, decreased muscle tone.
Retention of stool and urination.
Violation of speech and coordination of movements.
Lethargy and drowsiness.
Change in appetite.
Increase in body weight.
Violations hormonal background(impotence, violation menstrual cycle, breast enlargement in men, secretion of milk from the breast).
Delayed ejaculation.
Increasing photosensitivity.
Depression.
Violation of bone marrow hematopoiesis (agranulocytosis, anemia).
medicinal hepatitis.
Spasm mandible(lockjaw).
Dry mouth or vice versa, salivation.
Paralysis.
Akathisia (restlessness in one position, need for movement).
Pressure drop.
Tachycardia.
Increased intraocular pressure, cataract.
Drug-induced diabetes.
Disability with prolonged use and high doses.

Side effects of antipsychotic drugs must be compensated by prescribing nootropics or antidepressants. Adjusting the dose will help get rid of or reduce the harm of antipsychotics.

Important! Long-term use causes addiction to neuroleptics, slowly amenable to adjustment.

How to quit antipsychotics? The doctor who prescribed the antipsychotic drug gradually reduces the prescribed dose of the drug, sometimes instead of antipsychotics, they are gradually transferred to tranquilizers when anxiety states. To alleviate the withdrawal syndrome, B vitamins are used.

Classification

Classification of neuroleptics by chemical composition:

Phenothiazines and other tricyclics (Chlorpromazine, Trifluoroperazine, Promethazine).
Thioxanthenes (Truxal, Fluanxol).
Benzamides (Betamak, Tiaprid, Dogmatil, Topral, Eglonil).
Butyrophenones (Haloperidol).
Benzodiazepines (Diazepam, Gidazepam, Medazepam, Triazolam).
Benzisoxazole derivatives (Invega, Leptinorm, Rezalen, Rispen).
Piperazinylquinolinone derivatives (Ariperazole, Zilaxera, Amdoal).

Phenothiazines are classified according to chemical structure for connections with:

aliphatic bond;
piperidine core;
piperazine core.

The first group of phenothiazines causes tachycardia and extrapyramidal disorders to a lesser extent, while effectively relieving anxiety, having a strong sedative effect.

Piperazines, on the contrary, are characterized by a high risk of extrapyramidal disorders and have a weak sedative effect. Butyrophenone derivatives have similar effects.

Piperidines have a mild sedative effect. They are moderately strong antipsychotics. Their reception is accompanied severe dryness in the mouth and tachycardia due to the pronounced suppression of cholinergic receptors. Benzamides and thioxanthenes are close in action to piperidines.

Typical antipsychotics are divided into three groups according to their effects:

Sedatives that have a calming effect (Alimemazine, Chrorpromazine).
Disinhibiting, activating, with antidepressant effect (Sulpiride).
Incisive, powerful antipsychotics (Haloperidol, Trifluoperazine, Pipothiazine).

Atypical antipsychotics: Risperidone, Amisulpride, Clozapine, Asenapine, Quetiapine, Ziprasidone, Paliperidone. There are also antipsychotics with prolonged action: Moditen-Depot, Klopiksol-akufaz, decanoates.

Conclusion

There is no such thing as "the best antipsychotics", because with each pathological condition the most suitable drugs are selected in a particular case. When prescribing antipsychotics, the psychiatrist or psychotherapist should be informed about the patient's somatic diseases, especially glaucoma, tachyarrhythmia, kidney failure. These diseases are contraindications for the appointment of antipsychotics.

Antipsychotics are representatives of a large class of psychotropic drugs. The latter have a selective effect on the human psyche, i.e. on his thinking and emotions. Antipsychotics, in turn, slow down the neuropsychic processes and calm the person.

However, if these antipsychotics are prescribed to a healthy person, then a state of neurolepsy develops. It is characterized by the fact that any emotions are suppressed, both positive (joy, love) and negative (fear, anxiety), but the ability to think normally is preserved. Therefore, if antipsychotics are prescribed incorrectly, they turn healthy person into the soulless and indifferent.

Antipsychotics - what class of drugs

These drugs work by blocking nerve receptors. different classes. The most pronounced blockade of dopamine and serotonin receptors. It leads to the manifestation of an antipsychotic effect. Histamine, adrenergic and cholinergic are inhibited to a lesser extent. Such a complex receptor effect causes a number of positive impacts per patient:

Uniform suppression of symptoms of psychosis
Elimination of crazy ideas, hallucinations, disturbed behavior and thinking
Suppression of pathological disinhibition of drives, incl. and sexual
Activation of mental processes if they are suppressed (for example, with depression)
Improving the ability to think
General sedation and normalization of sleep in cases of severe insomnia.

Antipsychotics have more than just an antipsychotic effect. They also have other therapeutic effects.

Some of them can be used in medicine for the treatment of diseases not related to mental sphere. Others may cause adverse reactions when using neuroleptics. These drugs:

Enhance the effect of painkillers, especially from the group narcotic analgesics and deepen anesthesia
They have an antiemetic effect and also suppress hiccups
Reduce manifestations allergic reactions by blocking histamine receptors
increase the likelihood convulsive syndrome, because lower the minimum threshold of arousal
May cause tremors (trembling of the hands) due to the effect on dopamine receptors
They increase the secretion of prolactin, leading to the appearance of colostrum when pressing on the nipples, incl. and in men
In women, these drugs can cause menstrual irregularities, tk. reduce the production of FSH and LH and, accordingly, estrogen and progesterone
Reduce body temperature, bringing it closer to the temperature environment(this condition is called poikilothermia). This effect has been successfully exploited in surgical interventions on the heart and brain.

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Situations when antipsychotics are indispensable

Antipsychotics as drugs that interfere with the functioning of the brain, doctors prescribe only if special indications. These include:

psychoses
Schizophrenia
Alcohol addiction
Psychomotor agitation, when a person's irritability is accompanied by strong gestures and unmotivated movements
Manic states (this can be megalomania, persecution delusions, etc.)
Depression accompanied by obsessive delusions
Diseases in which involuntary muscle contractions are observed, grimacing
Insomnia unresponsive to other means
Vomiting of central origin, which cannot be controlled by other methods
Persistent hiccups
Severe anxiety
Stroke (antipsychotics protect well nervous tissue from progressive damage).

In addition, a person may be exposed to neuroleptics before surgery or other interventions accompanied by pain. They are used for induction into anesthesia and for neuroleptanalgesia (switching off pain sensitivity with muffled consciousness).

Side effects of antipsychotics - what to fear when taking them and what to do

The use of neuroleptics is serious treatment. It can be accompanied by various adverse reactions. Therefore, in the process of taking them, it is required to periodically visit a doctor to identify possible side effects and eliminate them in a timely manner. They can be varied:

Sharply developing muscular dystonia(manifested by spasm of the muscles of the face, tongue, back and neck, resembling an epileptic seizure)
Motor restlessness (unreasonable movements), with the appearance of which it is necessary to reduce the dose of the drug
Parkinson-like symptoms - masking of the face, trembling hands, shuffling when walking, muscle stiffness. These signs require the appointment of antiparkinsonian drugs.
Cardiac arrhythmias
Pressure drop when moving from horizontal to vertical position
Weight gain
Decrease in the number of leukocytes in the blood (every week a general clinical blood test is recommended)
Jaundice due to congestion of bile
Hyperprolactinemia, leading in men to impotence, and in women to menstrual irregularities and infertility
pupil dilation and hypersensitivity to the light
Eruptions on the skin.

In some cases, these drugs can cause depression. Therefore, some patients may require the appointment of tranquilizers at the first stage, and antipsychotics at the second stage.

Is it possible to cancel the neuroleptic on my own?

Long-term use of antipsychotic drugs leads to mental and physical addiction of the body. It is especially severe if the drug is canceled quickly. This leads to aggressiveness, depression, pathological arousal, emotional lability(causeless tearfulness), etc. Abrupt cancellation is fraught with aggravation of the course of the underlying disease. All these symptoms are very reminiscent of narcotic withdrawal.

Therefore, it is necessary to stop treatment with psychoactive substances only under the supervision of a doctor, following his recommendations. Dose reduction should be gradual with a simultaneous decrease in the frequency of administration. After that, antidepressants are prescribed, which will help overcome the formed neuroleptic dependence.

Despite the presence of side effects and addiction, antipsychotics are effective drugs in the treatment of many mental disorders. They help a person to return to the usual (normal) way of life. And it's worth it to endure unpleasant symptoms, the severity of which the doctor can minimize by making the correct appointment and cancellation.

Carefully! Antipsychotics!

Antipsychotics (also known as antipsychotics or strong tranquilizers) are a class of psychiatric drugs used primarily to control psychosis (including delusions, hallucinations, and thought disorders), in particular for and , and are increasingly being used to control non-psychotic disorders (ATC code N05A). The word "neuroleptic" comes from the Greek words "νεῦρον" (neuron, nerve) and "λῆψις" ("capture"). The first generation of antipsychotics, known as typical antipsychotics, were discovered in the 1950s. Most of the second generation drugs known as atypical antipsychotics were developed only recently, although the first atypical antipsychotic, clozapine, was discovered in the 1950s and introduced in clinical practice in the 1970s. Both generations of antipsychotics tend to block receptors in the brain's dopamine pathways, but atypical antipsychotics also generally act on serotonin receptors. Antipsychotics are more effective than placebo in treating the symptoms of psychosis, but some patients do not fully or even partially respond to treatment. The use of antipsychotics is associated with significant side effects, primarily movement disorders and weight gain.

medical application

Antipsychotics are most commonly used for the following indications:

Antipsychotics are used to treat dementia or insomnia only if other treatments have failed. They are used to treat children only if other treatments have failed or if the child is suffering from psychosis.

Schizophrenia

Antipsychotics are a key component of schizophrenia treatment recommended by the National Institute for Health and Clinical Excellence (NICE), the American Psychiatric Association, and the British Society for Psychopharmacology. The main effect of antipsychotic treatment is to reduce the so-called "positive" symptoms of the disease, including delusions and hallucinations. There is mixed evidence to support a significant effect of antipsychotics on negative symptoms(eg, apathy, lack of emotional affect, and lack of interest in social interactions) or cognitive symptoms (disordered thinking, reduced ability to plan and complete tasks) of schizophrenia. Overall, the effectiveness of antipsychotics in reducing positive and negative symptoms appears to increase with increasing severity of baseline symptoms. The use of antipsychotics in the treatment of schizophrenia includes prophylaxis in patients with symptoms suggestive of an increased risk of developing psychosis, treatment of the first episode of psychosis, supportive care, and treatment of recurrent episodes of acute psychosis.

Prevention of psychosis and improvement of symptoms

To evaluate patients with early symptoms of psychosis, lines of tests such as PACE (Personal Assessment and Crisis Assessment) and COPS (Prodromal Syndrome Criteria) are used to measure psychotic symptoms low level, and other tests focusing on cognitive impairment (main symptoms). Combined with information about family history, these tests can identify "high-risk" patients who have a 20-40% risk of disease progression to full-blown psychosis within 2 years. These patients are often prescribed low doses of antipsychotics to reduce symptoms and prevent the disease from progressing to full-blown psychosis. Despite the overall positive influence antipsychotics to reduce symptoms, clinical trials conducted to date provide little evidence that early use of antipsychotics, alone or in combination with cognitive behavioral therapy, provides improved long-term outcomes in patients with prodromal symptoms.

First episode of psychosis

NICE recommends that all individuals presenting with a first episode of full-blown psychosis be treated with antipsychotic medication and cognitive behavioral therapy (CBT). NICE recommends that CBT-only patients be warned that combined treatment is more efficient. The diagnosis of schizophrenia is usually not made at the first episode of psychosis because up to 25% of patients who seek help after the first episode of psychosis are eventually diagnosed with bipolar disorder. Treatment goals for these patients include symptom reduction and potential improvement in long-term outcomes. Randomized clinical trials have shown the effectiveness of antipsychotics in achieving the first goal, while first and second generation antipsychotics show equal effectiveness. The data that early start treatment has a beneficial effect on long-term treatment outcomes are controversial.

Recurrent psychotic episodes

Placebo-controlled trials of first- and second-generation antipsychotics consistently show superiority active drug compared with placebo in the suppression of psychotic symptoms. A large meta-analysis of 38 studies of antipsychotics in acute psychotic episodes of schizophrenia reported an effect size of about 0.5. There is almost no difference in efficacy among approved antipsychotics, including both first- and second-generation drugs. The effectiveness of such drugs is suboptimal. In several patients, complete resolution of symptoms has been achieved. Response rate calculated using various indicators symptom reduction was low. Data interpretation is complicated by high placebo response rates and selective publication of clinical trial results.

Supportive care

Most patients treated with antipsychotics show a response within 4 weeks. The goals of continued treatment are to maintain symptom suppression, prevent relapse, improve quality of life, and engage in psychosocial therapy. Maintenance therapy with antipsychotics is clearly superior to placebo in preventing relapse, but is associated with side effects such as weight gain, movement disorders and a high dropout rate of participants from the study. A 3-year trial of people receiving maintenance therapy after an acute psychotic episode found that 33% had a sustained improvement in symptoms, 13% achieved remission, and only 27% reported a satisfactory quality of life. The effect of relapse prevention on long-term outcomes is uncertain, and historical studies show little difference in long-term outcomes before and after administration of antipsychotics. An important challenge in the use of antipsychotics for relapse prevention is low rate compliance. Despite relatively high level side effects associated with these drugs, some evidence, including a high dropout rate of participants in the placebo group compared to treatment groups in randomized clinical trials, show that most patients who stop treatment do so because of suboptimal efficacy.

Bipolar disorder

Antipsychotics are often used in combination with mood stabilizers such as /valproate as first-line therapy for the treatment of manic and mixed episodes associated with bipolar disorder. The reason for using this combination is the therapeutic delay in the action of the aforementioned mood stabilizers (the therapeutic effects of valproate are usually observed after five days after the start of treatment, and lithium - at least a week) and the relatively rapid anti-manic effects of antipsychotic drugs. Antipsychotics have shown efficacy when used alone in acute manic/mixed episodes. Three atypical antipsychotics (lurasidone, olanzapine, and quetiapine) have also been found to be effective in treating bipolar depression with monotherapy. Only olanzapine and quetiapine have been shown to be effective against a wide range preventive action (i.e. against all three types of episodes - manic, mixed and depressive) in patients with bipolar disorder. A recent Cochrane review also found that olanzapine has a less favorable risk/benefit ratio than lithium as maintenance therapy for bipolar disorder. American Psychiatric Association and National Institute for Health and Excellence medical care UK recommend antipsychotics for the management of acute psychotic episodes in schizophrenia or bipolar disorder, and as a long-term maintenance treatment to reduce the likelihood of further episodes. They argue that the response to any neuroleptic may be different, so trials should be conducted in this direction, and that lower doses should be preferred when possible. A number of studies have observed levels of adherence to antipsychotic drug regimens and found that discontinuing them in patients is associated with more high rates relapse, including hospitalization.

Dementia

Testing for symptoms of dementia is required as an assessment of the underlying cause of the illness before antipsychotics are prescribed. When used in the treatment of dementia in the elderly, antipsychotics have shown modest efficacy compared with placebo in controlling aggression or psychosis and are sufficient a large number of serious side effects. Thus, antipsychotics are not recommended for routine use in the treatment of dementia with aggression or psychosis, but may be considered as an option in some cases where severe stress or the danger of causing physical harm to others. Psychosocial therapies may reduce the need for antipsychotic medications.

Unipolar depression

A number of atypical antipsychotics have some advantages when used in addition to other treatments for clinical depression. Aripiprazole, and olanzapine (when used in combination with ) have been approved by the US Food and Drug Administration (FDA) for this indication. Their use, however, is associated with increased risk side effects.

Other indications

In addition to the above indications, antipsychotics may be used to treat anxiety, personality disorders, and anxiety in patients with dementia. Evidence, however, does not support the use of atypical antipsychotics for disorders eating behavior or personality disorders. Risperidone may be useful in the treatment of obsessive-compulsive disorder. The use of low-dose antipsychotic drugs for insomnia, although common, is not recommended because there is little evidence of benefit and the risk of side effects. Low dose antipsychotics may also be used to treat impulsive behavioral and cognitive-perceptual symptoms. borderline disorder personality. In children, neuroleptics may be used in cases of disorders social behavior, mood disorders and general disorder psychological development or mental retardation. Antipsychotics are rarely recommended for the treatment of Tourette's syndrome because, despite their effectiveness, these drugs have a lot of side effects. The situation is similar for autism spectrum disorders. Most of data relating to off-label use of antipsychotics (eg, for dementia, OCD, post-traumatic stress disorder, personality disorder, Tourette's syndrome) have insufficient scientific evidence to support such use, especially when there is reliable evidence of an increased risk of stroke, convulsions, significant weight gain, sedative effect and gastrointestinal problems. A British review of the unlicensed use of antipsychotics in children and adolescents found similar findings and concerns. A survey of children with developmental disorders found that 16.5% of patients took antipsychotic drugs, most often for irritability, aggression and excitement. Risperidone has been approved by the US FDA for the treatment of irritability in autistic children and adolescents. Aggressive defiant behavior in adults with intellectual disabilities is often also treated with antipsychotics, despite the lack of evidence for such use. A recent randomized controlled trial, however, found no benefit of this treatment compared to placebo. The study did not recommend the use of antipsychotics as an acceptable permanent treatment.

Typical and atypical antipsychotics

It is not clear whether atypical antipsychotics (second generation) have an advantage over first generation antipsychotics. Amisulpride, olanzapine, risperidone, and clozapine may be more effective, but they also have more severe side effects. Typical and atypical antipsychotics have equal dropout rates and relapse rates when used at low to moderate doses. Clozapine is effective method treatments for patients who respond poorly to other drugs ('treatment-resistant' schizophrenia), but clozapine has the potentially serious side effect of agranulocytosis (a decrease in white blood cell count) in less than 4% of people. Due to research bias, the accuracy of comparing atypical antipsychotics is a problem. In 2005 government agency USA, National Institute mental health, published the results of a major independent study (the CATIE project). None of the atypical antipsychotics studied (risperidone, quetiapine, and ziprasidone) showed superiority over the typical antipsychotic perphenazine in the testing methods used, and these drugs caused no fewer side effects than the typical antipsychotic perphenazine, although large quantity patients discontinued perphenazine due to extrapyramidal effects compared to atypical antipsychotics(8% versus 2-4%). In terms of patient compliance with study medication instructions, no significant differences were found between the two types of neuroleptics. Many researchers question the usefulness of prescribing atypical antipsychotics as first-line drugs, and some even question the distinction between the two classes of antipsychotics. Other researchers point to much more high risk development of tardive dyskinesia and extrapyramidal symptoms when taking typical antipsychotics and for this reason alone recommend atypical drugs as first-line treatment, despite a greater risk of metabolic side effects. The UK government agency NICE recently revised its recommendations in favor of atypical antipsychotics, stating that the choice should be individual based on the specific drug profile and patient preferences.

Side effects

You should not take more than one antipsychotic drug at the same time, except in unusual circumstances due to an increase in the number and severity of side effects of the drugs. Common (≥ 1% and up to 50% of cases for most antipsychotics) side effects of antipsychotics include:

Lethargy (especially common with clozapine, olanzapine, quetiapine, chlorpromazine, and zotepine)

Headache

Dizziness

Anxiety

Extrapyramidal side effects (especially common with first-generation antipsychotics), including:

Akathisia is a feeling of inner restlessness.

Dystonia

parkinsonism

Hyperprolactinemia (rare with clozapine, quetiapine, and aripiprazole), which can lead to:

Galactorrhea - unusual secretion of breast milk.

Gynecomastia

Sexual dysfunction (in both sexes)

Osteoporosis

orthostatic hypotension

Weight gain (especially with clozapine, olanzapine, quetiapine, and zotepine)

Anticholinergic side effects (when taking olanzapine, clozapine, and less likely risperidone) such as:

blurred vision

Dry mouth (although salivation may also occur)

Decreased sweating

Tardive dyskinesia is more common in patients taking first-generation highly active antipsychotics such as haloperidol, and occurs mainly after chronic, rather than short-term, treatment. It is characterized by slow, repetitive, uncontrolled, and aimless movements, most commonly of the face, lips, legs, or torso, which are usually resistant to treatment and often irreversible. The frequency of PD is about 5% per year with the use of antipsychotic drugs (regardless of the drug used).

Rare/Uncommon (<1% случаев для большинства антипсихотических препаратов) побочные эффекты антипсихотических препаратов включают:

Weight gain as a result of histamine H1 and serotonin 5-HT2C receptor antagonism and possibly through interactions with other neurochemical pathways in the central nervous system

Neuroleptic Malignant Syndrome is a potentially life-threatening condition characterized by:

Autonomic instability, which can be manifested by tachycardia, nausea, vomiting, sweating, etc.

Hyperthermia - an increase in body temperature.

Change in mental status (confusion, hallucinations, coma, etc.)

Muscle stiffness

Laboratory abnormalities (eg, elevated creatinine kinase, decreased plasma iron, electrolyte disturbances, etc.)

pancreatitis

Increased QT interval, most notable in patients taking amisulpride, pimozide, sertindole, thioridazine, and ziprasidone

Convulsions, which are especially common in patients taking chlorpromazine and clozapine.

Thromboembolism

myocardial infarction

Ventricular tachycardia type "pirouette"

Some studies have shown a reduction in life expectancy associated with the use of antipsychotic drugs. Antipsychotics may also increase the risk of early death in people with dementia. Antipsychotics tend to worsen symptoms in people with depersonalization disorder. Antipsychotic polypharmacy (taking two or more antipsychotics at the same time) is common practice, but is not evidence-based or recommended, and there are initiatives to limit such use. In addition, the use of excessively high doses (often as a result of polypharmacy) continues despite clinical guidelines and evidence that such use is usually not more effective, but is usually associated with more harm to the patient.

Other

In schizophrenia, over time, there is a loss of gray matter in the brain and other structural changes. A meta-analysis of the effects of antipsychotic treatment on gray matter loss and structural changes shows conflicting findings. A 2012 meta-analysis found that patients treated with first-generation antipsychotics experienced greater gray matter loss compared to those treated with second-generation atypical antipsychotics. A protective effect of atypical neuroleptics has been proposed as one possible explanation. A second meta-analysis suggested that treatment with antipsychotics may be associated with increased gray matter loss. Latent, long-term forms of akathisia are often overlooked or mistaken for post-psychotic depression, particularly in the absence of the extrapyramidal aspect that psychiatrists expect when looking for signs of akathisia.

Discontinuation

Withdrawal symptoms from antipsychotic drugs may occur when dosage is reduced and when use is discontinued. Withdrawal symptoms may include nausea, vomiting, anorexia, diarrhea, rhinorrhea, sweating, myalgia, paresthesia, restlessness, agitation, and insomnia. The psychological symptoms of the syndrome may include psychosis, and may be mistaken for a relapse of the underlying illness. Improving withdrawal control may improve people's chances of successfully stopping antipsychotics. During withdrawal from antipsychotics, symptoms of tardive dyskinesia may decrease or persist. Withdrawal symptoms may occur when a patient switches from one antipsychotic to another (presumably due to differences in drug efficacy and receptor activity). Such symptoms may include cholinergic effects and movement syndromes, including dyskinesias. These side effects are more likely to occur when switching antipsychotics rapidly, so a gradual switch from one antipsychotic to another minimizes these withdrawal effects. The British National Formulary recommends phasing out when antipsychotic treatment is stopped to avoid acute withdrawal symptoms or rapid relapse. The process of cross-titration involves gradually increasing the dose of the new drug while gradually decreasing the dose of the old drug.

Mechanism of action

All antipsychotic drugs tend to block D2 receptors in the dopamine pathway in the brain. This means that dopamine released in these pathways will have less of an effect. Excess dopamine release in the mesolimbic pathway has been associated with psychotic experiences. It has also been shown that a decrease in dopamine release in the prefrontal cortex, as well as an excess of dopamine in all other pathways, have also been associated with psychotic experiences caused by abnormal functioning of the dopaminergic system in patients suffering from schizophrenia or bipolar disorder. Various neuroleptics, such as haloperidol and chlorpromazine, suppress dopamine in its pathways, ensuring the normal functioning of dopamine receptors. In addition to their dopamine antagonistic effects, antipsychotics (particularly atypical antipsychotics) also antagonize 5-HT2A receptors. Various alleles of the 5-HT2A receptor have been associated with the development of schizophrenia and other psychoses, including depression. There is evidence of higher concentrations of 5-HT2A receptors in cortical and subcortical areas, in particular, in the right caudate nucleus. The agonists of these same receptors are psychedelics, which explains the relationship between psychedelic drugs and schizophrenia. Typical antipsychotics are not particularly selective, they also block dopamine receptors in the mesocortical pathway, the tuberoinfundibular pathway, and the nigrostriatal pathway. Blocking D2 receptors in these other pathways is thought to produce some of the undesirable side effects of typical antipsychotics. They are usually classified on a spectrum from low to high potency, with potency referring to the drug's ability to bind to dopamine receptors rather than the potency of the drug. Active doses of highly potent neuroleptics such as haloperidol are as low as a few milligrams and cause less drowsiness and sedation than low-potency antipsychotics such as chlorpromazine and thioridazine, which have active doses of hundreds of milligrams. The latter has more pronounced anticholinergic and antihistamine activity, which may counteract the side effects associated with dopamine. Atypical antipsychotics have a similar blocking effect on D2 receptors, however, most of them also act on serotonin receptors, especially 5-HT2A and 5-HT2C receptors. Both clozapine and quetiapine have binding long enough to cause antipsychotic effects, but not long enough to cause extrapyramidal side effects and prolactin hypersecretion. 5-HT2A antagonism increases dopaminergic activity in the nigrostriatal pathway, resulting in a reduction in extrapyramidal side effects among atypical antipsychotics.

Story

The original antipsychotics were largely discovered by accident and then tested to see if they worked. The first neuroleptic, chlorpromazine, was developed as a surgical anesthetic. It was first used in psychiatry for its powerful sedative effect; at the time, the drug was considered a temporary "pharmacological lobotomy." Lobotomy was used at the time to treat many behavioral disorders, including psychosis, although its side effect was a marked reduction in behavioral and mental functioning of all kinds. However, chlorpromazine has been shown to reduce the effects of psychosis more effectively than lobotomy, even though it has strong sedative effects. The neurochemistry underlying its action has since been studied in detail, after which subsequent antipsychotic drugs have been discovered. The discovery of the psychoactive effects of chlorpromazine in 1952 led to a significant decrease in the use of methods such as mechanical restraint of the mentally ill, seclusion and sedation to control patients, and also led to further research, due to which tranquilizers and most other drugs were discovered. time to control mental illness. In 1952, Henri Labori described chlorpromazine as a drug that causes only the patient (non-psychotic, non-manic) to be indifferent to what is happening around. Jean Delay and Pierre Deniker have described it as a means to control mania or psychotic arousal. Delay claimed to have discovered a cure for anxiety applicable to all people, while Deniker's team claimed to have discovered a cure for psychotic illness. Prior to the 1970s, there was debate in psychiatry over the most appropriate term to describe new drugs. In the late 1950s, the most widely used term was "antipsychotics" and then "major tranquilizers", after which - "tranquilizers". The first recorded use of the term "tranquilizer" dates back to the early nineteenth century. In 1953, Frederick F. Jonkman, a chemist at the Swiss company Cibapharmaceutical, first used the term "tranquilizer" to differentiate reserpine from older generation sedatives. the word "neuroleptic" comes from the Greek: "νεῦρον" (neuron, originally meaning "veins", but today it means nerves) and "λαμβάνω" (lambanō, meaning "to possess"). Thus, the word means "to take control of the nerves." This may refer to the common side effects of neuroleptics, such as reduced activity in general, as well as lethargy and impaired movement control. Although these effects are unpleasant, and in some cases harmful, they, along with akathisia, were once considered a reliable sign that the drug was working. The term "ataraxia" was coined by the neurologist Howard Fabing and the classicist Alistair Cameron to describe the observed effect of mental indifference and withdrawal in patients treated with chlorpromazine. The term is derived from the Greek adjective "ἀτάρακτος" (ataraktos), meaning "undisturbed, unexcited, without confusion, steady, calm". In using the terms "tranquilizer" and "ataractic", physicians distinguished between "major tranquilizers" or "large ataractics", drugs used to treat psychosis, and "minor tranquilizers" or "minor ataractics" used to treat neuroses. While popular in the 1950s, these terms are rarely used today. These have now been abandoned in favor of the term "neuroleptics" (antipsychotics), which refers to the desired effects of a drug. Today, the term "minor tranquilizer" may refer to anxiolytics and/or hypnotics, such as and , which have some antipsychotic properties and are recommended for concurrent use with antipsychotic drugs and are useful for insomnia or narcotic psychosis. They are powerful sedatives (and have the potential to be addictive). Antipsychotics can be divided into two groups: typical antipsychotics (first generation drugs) and atypical antipsychotics (second generation antipsychotics). Typical antipsychotics are classified according to their chemical structure, while atypical antipsychotics are classified according to their pharmacological properties. They include serotonin-dopamine antagonists, multi-receptor antipsychotics (MARTA), and dopamine partial agonists, which are often categorized as atypical antipsychotics.

Society and culture

Sales

Antipsychotics were once among the most sold and profitable drugs. For example, in 2008, worldwide sales of antipsychotics were $22 billion. By 2003, an estimated 3.21 million patients were receiving antipsychotics in the United States, for a total of $2820,000,000. More than 2/3 of prescriptions were filled for new , the more expensive, atypical antipsychotics, each averaging $164 a year in sales, compared to $40 for older generation antipsychotics. By 2008, US sales reached $14.6 billion, making antipsychotics the top-selling drug class in the US.

Lineups

Antipsychotics are sometimes used as part of mandatory psychiatric treatment in an inpatient (hospital) or outpatient clinic. They can be given orally or, in some cases, as a long-acting (depot) injection into the gluteus or deltoid muscle.

controversy

Special patient groups

Individuals with dementia who exhibit behavioral and psychological symptoms should not take antipsychotics until other treatments have been tried. Antipsychotics increase the risk of cerebrovascular effects, parkinsonism or extrapyramidal symptoms, sedation, confusion and other cognitive adverse effects, weight gain, and increased mortality in this group of patients. Physicians and caregivers of people with dementia should try to treat symptoms, including agitation, aggression, apathy, anxiety, depression, irritability, and psychosis, using alternative therapies.

List of antipsychotics

List of used literature:

Finkel R, Clark MA, Cubeddu LX (2009). Pharmacology (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 151. ISBN 9780781771559.

Goikolea JM, Colom F, Torres I, Capapey J, Valentí M, Undurraga J, Grande I, Sanchez-Moreno J, Vieta E (2013). "Lower rate of depressive switch following antimanic treatment with second-generation antipsychotics versus haloperidol". J Affect Disord 144(3): 191–8. doi:10.1016/j.jad.2012.07.038. PMID 23089129.

"American Psychiatric Association Five Things Physicians and Patients Should Question". Choosing Wisely. Retrieved on September 23, 2013.

Toshi A. Furukawa, Stephen Z. Levine, Shiro Tanaka, Yair Goldberg, Myrto Samara, John M. Davis, Andrea Cipriani & Stefan Leucht (November 2014). "Initial Severity of Schizophrenia and Efficacy of Antipsychotics: Participant-Level Meta-analysis of 6 Placebo-Controlled Studies". JAMA psychiatry 72: 14. doi:10.1001/jamapsychiatry.2014.2127. PMID 25372935.

Leucht S, Arbter D, Engel RR, Kissling W, Davis JM (April 2009). How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Mol. Psychiatry 14(4): 429–47. doi:10.1038/sj.mp.4002136. PMID 18180760.

An antipsychotic is a special drug that is used for various mental disorders. As a rule, such drugs are used to treat neurotic syndromes, psychoses, and the medication can also be used for hallucinations. In addition, antipsychotic drugs are prescribed to prevent the main manifestations of a person's mental illness.

The main effects of the considered drugs

The effects of neuroleptics are multifaceted. The main pharmacological feature is a kind of calming effect, which is characterized by a decrease in response to external stimuli, a weakening of affective tension and psychomotor agitation, suppression of fear, and a decrease in aggressiveness. Antipsychotic drugs can suppress hallucinations, delusions and other psychopathological symptoms, have a therapeutic effect in patients suffering from schizophrenia and other psychosomatic ailments.

Certain drugs of this group have antiemetic activity, this effect of neuroleptics is achieved due to selective inhibition of chemoreceptor trigger (trigger) areas of the medulla oblongata. Some neuroleptics can have a sedative or activating (energizing) effect. A number of these funds are characterized by elements of normothymic and antidepressant action.

The pharmacological properties of various antipsychotic drugs are expressed to varying degrees. The combination of the main antipsychotic effect and other properties determines the profile of their impact and indications for use.

How do neuroleptics work?

Antipsychotics are drugs that depress the brain. The action of these drugs is also associated with the effect on the occurrence and conduction of excitation in various parts of the central and peripheral nervous system. Today, the most studied effect of neuroleptics is the effect on mediator processes in the brain. Scientists have accumulated enough data on the effects of these drugs on adrenergic, serotonergic, dopaminergic, cholinergic, GABAergic and other neurotransmitter processes, which include the effect on the neuropeptide systems of the brain. Particularly much attention has recently been paid to the process of interaction between dopamine brain structures and neuroleptics. With the inhibition of the mediator activity of dopamine, the main side effect of these drugs manifests itself, the so-called neuroleptic syndrome develops, which is characterized by extrapyramidal disorders, for example, such as involuntary muscle contraction, akathisia (restlessness), parkinsonism (tremor, muscle stiffness), motor restlessness, fever . This effect is achieved due to the blocking effect of neuroleptics on the subcortical formations of the brain, where a large number of receptors that are sensitive to dopamine are localized.

The manifested side effects of neuroleptics are a reason for correcting treatment and prescribing special correctors (drugs "Akineton", "Cyclodol").

Pharmacodynamics

An antipsychotic is a drug that, by acting on central dopamine receptors, provokes some endocrine disorders, including stimulation of lactation under their influence. When neuroleptics block the dopamine receptors of the pituitary gland, the secretion of prolactin increases. By acting on the hypothalamus, these drugs prevent the secretion of growth hormone and corticotropin.

Antipsychotics are drugs that have a relatively short half-life in the body and after a single administration they have a short effect. Scientists have created special preparations with a longer action (Moditen-Depot, Geloperidol Decanoate, Piportil L4, Clopixol-Depot). Often neuroleptics are combined with each other: in the first half of the day they take a stimulating drug, in the second - a sedative. In order to stop the affective-delusional syndrome, it is recommended to take antidepressants and antipsychotics in combination.

Indications for use

Antipsychotics are prescribed primarily for the treatment of nosogenic paranoid reactions (sensitive reactions) and chronic somatoform pain disorder.

Rules for prescribing these drugs

Treatment with antipsychotics begins with the appointment of an average therapeutic dose, then the effect is evaluated and a decision is made on the need to change the dose. The dosage of antipsychotics is quickly increased to a certain value, which is subsequently gradually reduced by 3-5 times, and the therapy becomes anti-relapse, supportive. Change the prescribed amount of the drug strictly on an individual basis. Maintenance doses are switched after the desired therapeutic effect is achieved. It is more expedient to carry out anti-relapse therapy with drugs that have a prolonged action. The route of administration of psychotropic drugs is of great importance. At the initial stage of treatment, parenteral administration is recommended, in which the relief of symptoms occurs faster (intravenous jet, intravenous drip, intramuscular). Further, it is preferable to take antipsychotics orally. A list of the most effective drugs will be given below.

The drug "Propazine"

This tool has a sedative effect, reduces anxiety and motor activity. The drug is used for borderline disorders in patients with, if there are anxiety, phobic disorders, obsessions. Take the medicine inside 2-3 times a day, 25 mg, if necessary - the dose can be increased to 100-150 mg per day. When using small doses, the development of manifestations of parkinsonism, as a rule, is not observed.

The drug "Etaperazine"

The drug has an antipsychotic activating effect and affects syndromes that are characterized by lethargy, lethargy, apathy. In addition, the drug "Etaperazine" is used to treat neurosis, accompanied by tension, fear, anxiety. The daily dose of the drug is 20 mg.

Means "Triftazin"

The drug has a noticeable anti-delusional effect, stops hallucinatory disorders. The drug has a moderate stimulating (energizing) effect. It can be used in the treatment of atypical depressive states with the phenomenon of obsession. For the treatment of somatoform disorders, the drug "Triftazin" is combined with antidepressants and tranquilizers. The dosage of the drug is 20-25 mg per day.

The drug "Teralen"

The drug has antihistamine and neuroleptic activity. The drug "Teralen" is a mild sedative and has a positive effect on synestopathic-hypochondriac signs of the borderline register, with psychosomatic symptoms that develop against the background of infectious, somatogenic, vascular manifestations, with neurovegetative pathologies. It is widely used in gerontological practice and pediatrics. Recommended for use in allergic diseases and skin itching. The drug is taken orally at 10-40 mg per day, intramuscularly used in the form of a 0.5% solution.

Means "Tiridazine"

The drug has an antipsychotic effect with a calming effect, without causing lethargy and lethargy. Also, the drug has a moderate thymoleptic effect. The drug shows the greatest effectiveness in emotional disorders, which are characterized by tension, fear, excitement. In the treatment of borderline conditions, 40-100 mg of the drug is used per day. With such phenomena as neurasthenia, increased irritability, anxiety, neurogenic functional gastrointestinal and cardiovascular disorders, take the medicine 2-3 times a day, 5-10-25 mg. With premenstrual nervous disorder - 1-2 times a day, 25 mg.

The drug "Chlorprothixen"

The drug has an antipsychotic and sedative effect, enhances the effect of sleeping pills. A medication is used for psychoneurotic conditions characterized by fears, anxieties. The use of the drug is indicated for neurosis, including against the background of a variety of somatic ailments, in case of sleep disturbance, skin itching, subdepressive states. The dose of the drug is 5-10-15 mg, take the medicine after meals, 3-4 times a day.

The drug "Flyuanksol"

This remedy has an antidepressant, activating, anxiolytic effect. In the treatment of depressive, apathetic conditions take 0.5-3 mg of medication per day. For the treatment of psychosomatic disorders with subdepression, asthenia, hypochondriacal manifestations, the daily dose is 3 mg. Fluanxol does not cause daytime sleepiness and does not affect attention.

Means "Eglonil"

The drug has a regulatory effect on the central nervous system, has a moderate antipsychotic activity, which is combined with some stimulating and antidepressant effects. It is used in conditions that are characterized by lethargy, lethargy, anergy. It is used in patients with somatoform, somatized disorders on the background of subdepressive mood and in skin ailments accompanied by itching. This medication is especially indicated for use in patients who have a latent form of depression, senestopathic disorders. It is also recommended to use the drug "Eglonil" for depression with pronounced sensations such as dizziness and migraines. The tool also has a cytoprotective effect on the gastric mucosa, so it is used to treat conditions such as gastritis, duodenal ulcer and gastric ulcer, irritable bowel syndrome, Crohn's disease. The recommended dose of the drug is 50-100 mg per day, the daily dose, if necessary, can be increased to 150-200 mg. The drug can be taken in combination with sedative antidepressants.

Side effects of neuroleptics

Like any other medication, antipsychotics also have negative sides, the reviews of those who used such drugs indicate the possible development of undesirable effects. Long-term or incorrect use of these drugs can cause the following effects:

All movements are accelerated, a person moves for no reason in different directions, usually at high speed. You can get rid of calm down, find a comfortable position only after taking psychotropic drugs.

There is a constant movement of the eyeballs, facial muscles and various parts of the body, grimacing.

Due to damage to the muscles of the face, its features change. A “skewed” face may never return to its normal state, it may remain with a person until the end of his life.

As a result of intensive therapy with antipsychotics and depression of the nervous system, severe depression develops, which significantly affects the effectiveness of treatment.

An antipsychotic is a drug that has a direct effect on the gastrointestinal tract, therefore, during treatment with this medication, discomfort in the stomach and dry mouth may be felt.

Such substances that are part of neuroleptics, such as thioxanthene and phenothiazine, negatively affect human vision.

Atypical antipsychotics

These drugs act more on serotonin receptors than dopamine receptors. Therefore, their anti-anxiety and calming effect is more pronounced than antipsychotic. Unlike typical antipsychotics, they affect brain function to a lesser extent.

Consider the main atypical antipsychotics.

Medication "Sulpiride"

This drug is used to treat conditions such as somatized mental disorders, hypochondriacal, senestopathic syndromes. The drug has an activating effect of action.

The drug "Solian"

The action of this remedy is similar to the previous drug. It is used in conditions with hypobulia, apathetic manifestations, with the aim of stopping

Means "Clozapine"

The drug has a pronounced sedative effect, but does not cause depression. The drug is used in the treatment of catatonic and hallucinatory-delusional syndromes.

Means "Olanzalin"

The drug is used for psychotic disorders and catatonic syndrome. With prolonged use of this medication, obesity may develop.

The drug "Risperidone"

This atypical remedy is used most widely. The drug has an elective effect in relation to hallucinatory-delusional symptoms, catatonic symptoms, obsessive-compulsive states.

Means "Rispolept-consta"

This is a long-acting medication that ensures the stabilization of the well-being of patients. Also, the tool shows high efficiency in relation to acute endogenous genesis.

Medication "Quetiapin"

This drug, like other atypical antipsychotics, acts on both dopamine and serotonin receptors. It is used for paranoid, manic excitement. The drug has an antidepressant and moderately pronounced stimulating effect.

The drug "Ziprasidone"

The agent affects dopamine D-2 receptors, 5-HT-2 receptors, and also blocks the reuptake of norepinephrine and serotonin. This determines its effectiveness in the treatment of acute hallucinatory-delusional, as well as affective disorders. The use of the drug is contraindicated in arrhythmia and the presence of pathologies of the cardiovascular system.

Means "Aripiprazole"

The drug is used for all types of psychotic disorders. The drug contributes to the restoration of cognitive functions in the treatment of schizophrenia.

Means "Sertindol"

The drug is used for sluggish-apathetic conditions, the drug improves cognitive functions, has antidepressant activity. Sertindol is used with caution in cardiovascular pathologies - it can provoke arrhythmia.

The drug "Invega"

The drug prevents exacerbation of catatonic, hallucinatory-delusional, psychotic symptoms in patients with schizophrenia.

Side effects of atypical antipsychotics

The action of drugs such as Clozapine, Olanzapine, Risperidone, Ariprazol is accompanied by the phenomenon of neurolepsy and significant changes in the endocrine system, which can cause weight gain, the development of bulimia, and an increase in the level of certain hormones (prolactin). In the treatment of Clozapine, agranulocytosis may also occur. Taking Quetiapine often causes drowsiness, headaches, increased levels of hepatic transaminases, and weight gain.

It is worth noting that today scientists have accumulated enough information indicating that the superiority of atypical antipsychotics over typical ones is not so significant. And their reception is prescribed when, with the use of typical antipsychotics, a significant improvement in the patient's condition is not observed.

Antipsychotic withdrawal syndrome

Like any other drug with psychoactive properties, antipsychotic drugs cause a strong psychological and physical dependence. Abrupt withdrawal of the drug can provoke the development of severe aggression, depression. The person becomes too impatient, whiny. There may also be signs of a disease for which antipsychotics were used.

From a physiological point of view, the manifestations during the abolition of antipsychotics are similar to the symptoms during the abolition of drugs: a person is tormented by painful sensations in the bones, he suffers from headaches, insomnia. Nausea, diarrhea and other intestinal disorders may develop.

Psychological dependence does not allow a person to refuse to use these means, because he is tormented by the fear of returning to a gloomy, depressive life.

How to stop taking antipsychotics without disturbing the normal state of health? First of all, you should know that it is contraindicated to use antipsychotics without a doctor's prescription. Only an experienced specialist is able to adequately assess the patient's condition and prescribe the necessary treatment. Also, the doctor will give recommendations on reducing the dose of the medication consumed. The dosage of the drug should be reduced gradually, without causing a strong feeling of discomfort. Further, the specialist prescribes antidepressants that will support the patient's emotional state and will prevent the development of depression.

An antipsychotic is a drug that allows you to normalize a person's mental state. However, in order to avoid the development of side effects, be sure to follow the doctor's recommendations and do not self-medicate. Be healthy!