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Psy 103-Schizophrenia

Motor side effects much greater wclassical

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Motor side effects (much greater w/classical antipsychotics like Thorazine and Haldol): Akathisia (“cruel restlessness”), e.g., rocking, “Thorazine shuffle” Acute dystonias (lock-jaw, oculogyric crisis(locke of eyes)) – locking of muscles. A shot of benadryl loosens up the muscle, knocks out the symptom Pseudoparkinsonism – producing what looks like parkinsons disease, mostly the first gen meds. Resting Tremor Slowness of movements Muscular rigidity Tardive dyskinesia (rare with 2 nd -generation medications) – if you take the antipsychotic long enough. Sticks with you forever Early “rabbit sign” Eventually, tongue and limb writhing Phases of “Clinical Trials” in Medication Development Phases of “Clinical Trials” in Medication Development Phase I – conducted in a small group of people (20-80) to assess safety, dosage range, and possible side effects. The primary goal of these trials is to look at the overall safety of a given medication. Phase I studies may last several months. Phase II – further assessment of efficacy and safety in a larger group of people (100-300). Although safety is still a serious consideration, the primary goal of Phase II trials is to determine effectiveness. Phase II studies will last from several months to up to two years. Phase III – testing with approximately 1000-3000 subjects to confirm efficacy, compare with other treatments, monitor safety and side effects. Phase III trials can last from 1-4 years, and are a final consideration of safety, effectiveness, and dosage of a given medication.
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Phase IV – Post-marketing studies to gather further information about safety, efficacy or optimal use. Only 25-30% of candidate medications proceed to Phase III trials, and only 20% are ever marketed. Bringing a new drug to market typically costs $200 million to $800 million, and takes 10-15 years. Other Disorders (Usually with Psychotic Features) In Which Other Disorders (Usually with Psychotic Features) In Which Antipsychotic Medications Are Sometimes Used: Antipsychotic Medications Are Sometimes Used: Major Depression Bipolar Disorder (several antipsychotic medications such as Abilify are FDA-approved for both schizophrenia and bipolar disorder) Paranoid, Schizoid and Schizotypal Personality Disorders Borderline Personality Disorder Post-traumatic Stress Disorder Intense anxiety with psychotic features (e.g., Brief Psychotic Episodes, encephalopathies, etc.) Agitation in the elderly (especially at nightfall: “sundowner’s syndrome”) Prognosis in Schizophrenia Prognosis in Schizophrenia Formerly, “Rule of thirds” 1/3 improve, 1/3 stay same, 1/3 deteriorate – too optimistic rule probably reflects misdiagnosed bipolar disorder Now, outlook is considered more dismal. On 30-year follow-up: 20 % show good adjustment 35 % show fair adjustment 45 % incapacitated Prognosis worse for – symptom schizophrenia New medications may improve prognosis Incidence of schizophrenia appears to be declining world-wide, perhaps due to better infant nutrition and childbirth methods. Could be b/c
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of flu vaccination around the world, preventing maternal infection, cleanliness, suction cup for babies. End End
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