Central Nervous System Regulation, Mood, and Cognition
Central Nervous System Regulation, Mood, and Cognition
8.9 Antipsychotics
Open Resources for Nursing (Open RN)
Antipsychotic drugs are used to treat drug-induced psychosis, schizophrenia, extreme mania, depression that is resistant to other therapy, and other CNS conditions. Antipsychotics are sometimes referred to as tranquilizers because they produce a state of tranquility. First-generation antipsychotics, also called conventional antipsychotics, have similar mechanisms of action. An example of a conventional antipsychotic is haloperidol. Conventional antipsychotics have several potential adverse effects, and the selection of a medication is based on the client’s ability to tolerate the adverse effects. Second-generation antipsychotics also referred to as atypical antipsychotics, have fewer adverse effects. An example of an atypical antipsychotic is risperidone.[1] Both conventional and atypical antipsychotics have a Black Box Warning indicating that elderly clients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.
1st and 2nd Generation Antipsychotics
Mechanism of Action
All antipsychotics block dopamine receptors in the brain. However, the precise mechanism of action has not been clearly established. Conventional antipsychotics, such as haloperidol, block dopamine receptors in certain areas of the CNS, such as the limbic system and the basal ganglia. These areas are associated with emotions, cognitive function, and motor function, and blockage thus produces a tranquilizing effect in psychotic clients. However, several adverse effects are also caused by this dopamine blockade.
Second-generation, or atypical, antipsychotics block specific dopamine 2 receptors and specific serotonin 2 receptors, thus causing fewer adverse effects.
Indications for Use
Haloperidol is primarily indicated for schizophrenia and Tourette’s disorder. Risperidone is primarily indicated for schizophrenia but is also used for acute manic episodes and for irritability caused by autism. Some atypical antipsychotics are also used as an adjunct therapy for depression or nausea.
Nursing Considerations Across the Lifespan
Elderly clients with dementia-related psychosis treated with antipsychotic drugs should be closely monitored for signs and symptoms of cardiovascular events or infections such as pneumonia.
Haloperidol is contraindicated in clients with Parkinson’s disease or dementia with lewy bodies.
Clients who are concurrently taking lithium and antipsychotics should be monitored closely for neurotoxicity (weakness, lethargy, fever, tremulousness, confusion, and extrapyramidal symptoms) and symptoms should be immediately reported.
Adverse/Side Effects
Elderly clients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death due to cardiovascular or infection-related causes.
Conventional antipsychotic medications have several potential serious adverse effects such as tardive dyskinesi