o Standardized screening tool Abnormal involuntary movement scale AIMS Facial

O standardized screening tool abnormal involuntary

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o Standardized screening tool – Abnormal involuntary movement scale (AIMS) Facial and oral movements Extremity movements Trunk movements Global judgement Dental status o o Neuroleptic Malignant Syndrome o Possibly fatal side effect of neuroleptics o Non-dose related Can happen with any antipsychotic not specific to a certain generation o Fever and rigidity *** cardinal signs o Confusion, Convulsions, Death o Rx-stop neuroleptic- emergency care o Falter F - Fever A - Autonomic instability (increased HR) L - Leukocytosis T - Tremors E - Elevated CPK CPK: creatine phosphokinase, enzyme found in heart, skeletal muscle and brain. R – Rigidity o Hot, Stiff and Out of it Hot - Fever >102 Stiff - Muscle stiffness Out of it – Confusion o EPSEs Treatment o Medications for EPSEs Benadryl (Diphenhydramine) Artane (Trihexyphenidyl) Cogentin (Benztropine) o First Generation Side Effects o Photophobia o Leukocytosis o Orthostatic hypotension o Anti-cholinergic effects Dry mouth Dry eyes Constipation Blurred vision
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Photosensitivity Urinary retention o Atropine Psychosis Confused Fever Anticholinergic Diplopia 2 nd Generation Anti-psychotics o Block both dopamine and serotonin receptors o Clozaril (Clozapine) o Risperidone (Risperdal & Risperdal CONSTA) - (Increases Prolactin) o Zyprexa (Olanzapine) - most weight gain o Geodon (Ziprasidone) o Quetiapine (Seroquel) - check eyes (cataracts) The Four New Atypicals (2 nd Generation) o Paliperidone (Invega) o Iloperidone (Fanapt) o Asenapine (Saphris) o Lurasidone (Latuda)-also used for bipolar Dx Long Acting Antipsychotics o Aripiprazole (Abilify Maintena) o Aripiprazole lauroxil (Aristada) o Fluphenazine (Prolixin) o Haloperidol (Haldol decanoate) o Olanzapine pamoate (Zyprexa Relprevv) o Paliperidone (Invega Sustenna, Invega Trinza) o Risperidone (Risperdal Consta) Clozaril (Clozapine) – 2 nd Generation o Best anti-psychotic o Used for non-responders o Expensive o Agranulocytosis Weekly labs for 6 months o Seizures o Excessive salivation o Myocarditis Agranulocytosis o Leukopenia: Decrease in total leukocyte count o Neutropenia: Decrease in neutrophil count <1500/microL o Agranulocytosis: Severe neutropenia < 500 neutrophils/microL Second Generation S/E’s o Metabolic Syndrome Weight gain Risk for development of Diabetes Mellitus Dyslipidemia o Galactorrhea o Impotence 3 rd Generation Anti-psychotics o Work differently than the others o Abilify (Ariprazole) is the only 3 rd generation agent o Dopamine stabilizer o Much better safety profiles o Improves both + and – symptoms o Minimal side effects Antipsychotic Pearls o 1 st generation (traditional) treats positive symptoms o 2 nd and 3 rd generation (atypical) reduce both (+) and (-) symptoms
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o Most schizophrenic patients do not have a total remission but a reduction of symptoms.
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