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Clinician’s Corner: Introduction to Antipsychotic Drugs

Most of the over 50 crowd remembers the State Mental Hospital in Hollidaysburg, currently the site of the Veterans Home. As the care of the mentally ill changed from hospital care to outpatient care, the patient population dwindled until a decision was made in the 1970s to shut it down. Since 1955 there has been a decline by 95% of available beds to treat the mentally ill.

Between 1954 and 1975, about 15 antipsychotic drugs were introduced in the United States. Thorazine (Chlorpromazine) by SK&F was the first available. This drug began the exodus of patients from our mental hospitals.  Almost 66 years later these medications still have their place in therapy.

Schizophrenia…the Basics

  • Schizophrenia affects about 1% of the world’s population
  • diagnosed primarily on the presentation of psychotic symptoms (hallucinations and delusions)
  • patients suffering from schizophrenia often present themselves with concomitant negative symptoms (e.g. apathy, anhedonia) and cognitive dysfunction.
  • The dopamine (D2) receptor is responsible for schizophrenia- most drugs are aimed at that receptor.
  • Since 1953, a total of 19 studies of toxoplasmosis (T. gondii) antibodies in persons with schizophrenia and other severe psychiatric disorders and in controls have been reported; 18 reported a higher percentage of antibodies in the affected persons; in 11 studies the difference was statistically significant. Two other studies found that exposure to cats in childhood was a risk factor for the development of schizophrenia. https://wwwnc.cdc.gov/eid/article/9/11/03-0143_article

Researchers have been able to confirm that patients with schizophrenia show increased

  • Dopamine receptors Schizophrenia patients make more dopamine and release more dopamine.
  • Serotonin receptors help with aggression and anxiety control but also leading to weight gain and ejaculation difficulties.
  • Histamine receptors cause drowsiness and weight gain.
  • Adrenergic receptors lower blood pressure, reflex tachycardia, vertigo, sedation, hypersalivation and incontinence, weight gain as well as sexual dysfunction.
  • Muscarinic receptors cause symptoms such as dry mouth, blurred vision, constipation, difficulty or inability to urinate, heart rhythm changes and loss of memory

As a group, the typical antipsychotics are dopamine receptor antagonists (D2 receptors) block certain dopamine tracts in the brain:

  • nigrostriatal: movement disorders (bad)
  • mesolimbic: relief of hallucinations & delusions (good)
  • mesocortical: relief of psychosis & worsening of negative symptoms (good)
  • tuberoinfundibular: prolactin release (bad0
  • In general, efficacy in treating patients with schizophrenia is similar for all of these agents. They differ by side effect profiles.

With a 95% decrease in available mental health beds, and with 45% of homeless patients suffering from mental illness (Mentalillnesspolicy.org), we obviously need better medications for the treatment of schizophrenia.  140,000 mentally ill patients are homeless; 392,000 seriously mentally ill patients are incarcerated. 1.2% of Americans (3.2) million are afflicted with this disease. Individuals with schizophrenia die at a younger age than do healthy people. Males have a 5.1 greater than expected early mortality rate than the general population, and females have a 5.6 greater risk of early death. Suicide is the single largest contributor to this excess mortality rate, which is 10 to 13 percent higher in schizophrenia than the general population. Obviously, we need a better strategy to treat this disabled group of citizens.

A excellent fact sheet is available at https://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml

Your Thompson cares about your physical and mental health.  Our pharmacists can help your physician decide what therapies are most cost effective and help ensure that you take your medications exactly as prescribed.  Go Ahead and ASK… at Thompson Pharmacy it’s All for YOU!