scholarly journals Trends of Anticholinergics and Antipsychotics Prescribing at Chainama Hills College Hospital, Lusaka-Zambia

2021 ◽  
Vol 3 (2) ◽  
pp. 24-31
Author(s):  
Francisca T Bwalya ◽  
◽  
James Mwanza ◽  
Paul Ravi ◽  
◽  
...  
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Treatment Guidelines ◽  
Anticholinergic Drug ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Anticholinergic Drugs ◽  
Typical Antipsychotic ◽  
Extrapyramidal Side Effects ◽  
College Hospital

Introduction:Antipsychotics are the main pharmacological treatment for psychosis. Anticholinergic drugs are sometimes prescribed with antipsychotics to treat or as prophylaxis for extrapyramidal side effects. Antipsychotic treatment guidelines recommend that anticholinergics should not be prescribed indiscriminately as prophylaxis for extrapyramidal side effects to patients using antipsychotic drugs, but only when there is high risk or evidence of extrapyramidal side effects, as they can cause significant central and peripheral side effects which have a potential to affect treatment outcomes. The objective of the study was to assess the trends in the prescribing of antipsychotics and anticholinergics.Methods:A cross sectional study was conducted at Chainama Hills College Hospital in Zambia. An open-ended questionnaire was administered to 26 prescribers and 311 files for patients were reviewed who had an antipsychotic or anticholinergic drug prescribed. The prescription pattern of patient files was compared with theNational Institute for Health and Care Excellenceguidelines as a gold standard.Results:The antipsychotic distribution showed that 76.1% were prescribed a typical antipsychotic, 18.1% an atypical antipsychotic and 5.8% were on both typical and atypical antipsychotic. 28.2% of the patients on antipsychotics were prescribed anticholinergics (Trihexyphenidyl). 46.2% of the prescribing clinicians stated that they prescribe anticholinergics when a patient develops extrapyramidal side effects rather than concurrently with antipsychotics or when a high dose of antipsychotics has been prescribed.Conclusion:The trend in antipsychotic and anticholinergic prescribing in Lusaka-Zambia were not consistent with recommended guidelines. Majority of patients are on typical antipsychotics rather than atypical antipsychotics. Most patients were administered above optimal dose of antipsychotics though polypharmacy was solemnly practiced. Recommend that further studies to explore factors contributing to this trend are conducted.

ICI 204, 636: A New Atypical Antipsychotic Drug

1996 ◽  
Vol 168 (S29) ◽  
pp. 45-56 ◽  
Author(s):  
Steven R. Hirsch ◽  
Christopher G. G. Link ◽  
Jeffrey M. Goldstein ◽  
Lisa A. Arvanitis
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drug ◽  
Antipsychotic Agents ◽  
Pharmacological Action ◽  
Therapeutic Effects ◽  
Typical Antipsychotic ◽  
Extrapyramidal Side Effects ◽  
Dopaminergic Receptors ◽  
Atypical Antipsychotic Drug

The therapeutic effects of ‘classic’ (typical) antipsychotic agents lie in their ability to block central dopaminergic receptors – a property that is also responsible for the frequent occurrence of undesirable extrapyramidal side-effects (EPS). In contrast to these typical agents, clozapine alone has distinguished itself in humans – by virtue of its enhanced antipsychotic action and lack of concurrent EPS – as an atypical antipsychotic. However, the use of clozapine has been limited by the occurrence of agranulocytosis and, to a lesser extent, seizures (Alvir et al, 1993; Haring et al, 1994). The mechanism underpinning the atypical profile of clozapine remains elusive. One hypothesis suggests that it lies in clozapine's higher serotonin 5-HT2: D2 binding ratio, when compared with typical agents – a factor being considered as a predictor of atypicality (Meltzer, this issue; Meltzer et al, 1989). However, an emerging view is that it is not a single pharmacological action, but rather multiple properties that may define an atypical, clozapine-like compound (Lieberman, 1993).

Psychopharmacology of olanzapine

1999 ◽  
Vol 174 (S38) ◽  
pp. 52-58 ◽  
Author(s):  
C. M. E. Stephenson ◽  
L. S. Pilowsky
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drug ◽  
Therapeutic Efficacy ◽  
Atypical Antipsychotics ◽  
Extrapyramidal Side Effects ◽  
Atypical Antipsychotic Drug ◽  
Blood Monitoring

The development of atypical antipsychotics has revolutionised the treatment of schizophrenia, as well as providing new insights into its cause. The archetypal atypical antipsychotic is clozapine, which has therapeutic advantages over traditional antipsychotics, as well as a low potential for producing extrapyramidal side-effects (EPS) (Kane et al, 1988). However, clozapine causes agranulocytosis in 1% of patients, and there has consequently been a search for novel atypical antipsychotics, as efficacious as clozapine, but without the need for intensive blood monitoring. There has been much discussion of the definition and characteristics of an atypical antipsychotic drug, and an operational understanding seems to have been agreed upon, that atypical drugs have therapeutic efficacy in treating schizophrenia, without producing EPS (Deutch et al, 1991; Kerwin, 1994).

Neuroleptic Prescription for Chinese Schizophrenics in Hong Kong

1992 ◽  
Vol 26 (2) ◽  
pp. 262-264 ◽  
Author(s):  
Helen Chiu ◽  
Sing Lee ◽  
C.M. Leung ◽  
Y.K. Wing
Keyword(s):  
Hong Kong ◽  
Side Effects ◽  
High Frequency ◽  
Anticholinergic Drugs ◽  
Extrapyramidal Side Effects ◽  
High Potency ◽  
Frequency Of Use ◽  
Daily Dose ◽  
Schizophrenic Patients ◽  
The Mean

There are very few studies on the pattern of neuroleptic prescription for schizophrenics in Asia. 106 schizophrenic patients in a psychiatric unit of a general teaching hospital in Hong Kong were surveyed. The mean daily dose (in chlorpromazine equivalent) was low (568.5mg). The mean daily dose of high potency agents was four times that of low potency agents. A high frequency of use of anticholinergic drugs may indicate that Chinese are more susceptible to acute extrapyramidal side-effects.

Antipsychotic treatment in older schizophrenia patients with extrapyramidal side effects in Asia (2001 – 2009)

2012 ◽  
Author(s):  
Yu-Tao Xiang ◽  
Julie Kreyenbuhl ◽  
Faith B. Dickerson ◽  
Gabor S. Ungvari ◽  
Chuan‑Yue Wang ◽  
...  
Keyword(s):  
Side Effects ◽  
Antipsychotic Treatment ◽  
Extrapyramidal Side Effects

Intramuscular maintenance treatment with ultra-high-dose long-acting injectable aripiprazole in an elderly patient suffering from chronic refractory schizophrenia: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S573-S573 ◽  
Author(s):  
L. Bartova ◽  
M. Dold ◽  
N. Praschak-Rieder ◽  
A. Naderi-Heiden ◽  
S. Kasper
Keyword(s):  
Side Effects ◽  
Maintenance Treatment ◽  
Rating Scale ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Symptom Scale ◽  
Meaningful Improvement ◽  
Plasma Level Monitoring ◽  
Competing Interest ◽  
Long Acting

Long-acting injectable (LAI) aripiprazole is increasingly appreciated in the course of a maintenance treatment of schizophrenia due to efficacy in delaying – and decreasing relapse, and low rates of feared side effects. In line with the prescribing information, the maximal starting – as well as maintenance dose was restricted to 400 mg following a 26-day interval between the single doses.We present a 72-year-old female inpatient (66 kg) with an acute exacerbation of chronic refractory schizophrenia, exhibiting primarily positive symptoms including excessive persecutory delusions, self-care deficit, poor insight and insufficient adherence to continuous intake of oral medication. Since she developed a post-injection syndrome after an accidental intravascular administration of olanzapine LAI 405 mg, the antipsychotic treatment was switched to aripiprazole LAI 300 mg once monthly. Due to insufficient clinical response, aripiprazole LAI was gradually increased up to 1200 mg per month under continuous plasma level monitoring. Here, 2 single injections of aripiprazole LAI 300 mg were delivered into both gluteal muscles concurrently, every 14 days.Consequently, we observed a clinically meaningful improvement (a total-score reduction from 111 to 75 on the Positive and Negative Syndrome Scale), as well as no objectifiable side effects, assessed by “The Dosage Record Treatment Emergent Symptom Scale” and “The Barnes Akathisia Rating Scale”, despite multi-morbidity and rather advanced age of the patient.Our safe experience with applying the almost threefold higher monthly dose over 12 weeks may encourage researchers to further investigate the efficacy, tolerability as well as handling of highly dosed aripiprazole LAI in refractory schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Receptor mechanisms of antipsychotic drug atypicality

1998 ◽  
Vol 13 (S1) ◽  
pp. 5s-8s
Author(s):  
GP Reynolds
Keyword(s):  
Side Effects ◽  
Animal Models ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Mechanisms Of Action ◽  
Antipsychotic Treatment ◽  
Extrapyramidal Side Effects ◽  
Treatment Resistant ◽  
Pharmacological Profile ◽  
New Compounds

SummaryRecent advances in antipsychotic treatment of schizophrenia have offered several new compounds which avoid many of the limitations of the classical antipsychotics. These so-called ‘atypical’ antipsychotics have fewer extrapyramidal side effects, greater efficacy against negative symptoms and greater efficacy in otherwise treatment-resistant patients. However, the mechanism of action of these atypical antipsychotics is still unclear. The several receptors currently implicated in the pharmacological profile of these atypical antipsychotics include subtypes of those for dopamine, serotonin, noradrenaline, and acetylcholine among others. The current hypotheses for possible mechanisms of action of atypical antipsychotics are discussed along with the experimental correlates of antipsychotic efficacy in animal models.

scholarly journals Irreversible effects of anticholinergic withdrawal in the elderly: a case report

2021 ◽  
Vol 3 (2) ◽  
pp. 28-31
Author(s):  
Charisse Chehovich ◽  
Keyword(s):  
Side Effects ◽  
First Generation ◽  
The Elderly ◽  
Anticholinergic Drugs ◽  
Extrapyramidal Side Effects ◽  
Abrupt Withdrawal ◽  
Acute Hospitalization ◽  
Anticholinergic Effects ◽  
Irreversible Effects ◽  
Withdrawal Effects

Anticholinergics, such as benztropine and trihexyphenidyl, are a class of medications that have been used to treat several different conditions including antipsychotic-induced extrapyramidal side effects (EPS) that are most often associated with first-generation antipsychotics (FGAs), such as haloperidol and fluphenazine. Many other medications, including antimuscarinics, antipsychotics, and antidepressants, also have anticholinergic effects. In this report, we review the case of an 80-year-old male who experiences irreversible anticholinergic withdrawal effects following the discontinuation of trihexyphenidyl and trospium secondary to side effects. Discontinuation of anticholinergics must be approached with care as abrupt withdrawal can lead to cholinergic rebound and muscular rigidity, and in some cases can lead to acute hospitalization and an inability to return to baseline functioning, as seen in our elderly patient. Keywords: Anticholinergic withdrawal, trihexyphenidyl, trihexyphenidyl withdrawal, trospium, anticholinergic drugs, cholinergic rebound

Association of MTHFR 677C > T genetic polymorphism with extrapyramidal side effects of antipsychotic treatment

Gene Reports ◽  
2020 ◽  
Vol 20 ◽  
pp. 100717
Author(s):  
T.V. Zhilyaeva ◽  
E.V. Akimova ◽  
A.V. Sergeeva ◽  
A.S. Blagonravova ◽  
G.E. Mazo
Keyword(s):  
Genetic Polymorphism ◽  
Side Effects ◽  
Antipsychotic Treatment ◽  
Extrapyramidal Side Effects

Antipsychotic and anticholinergic drugs

2012 ◽  
pp. 1208-1231
Author(s):  
Herbert Y. Meltzer ◽  
William V. Bobo
Keyword(s):  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Anticholinergic Drugs ◽  
Typical Antipsychotic ◽  
Drug Induced ◽  
Atypical Antipsychotic Drugs ◽  
Normal Limits ◽  
Psychotic Features

The discovery by Delay and Denicker in 1953 that chlorpromazine was highly effective in alleviating delusions, hallucinations, and disorganized thinking, was the seminal breakthrough in the treatment of schizophrenia, the first agent to produce sufficient relief of core psychotic symptoms to permit life outside of institutions for many patients with schizophrenia, and even a return to a semblance of function within normal limits. Chlorpromazine and the other related typical antipsychotic drugs which were introduced over the next 30 years have proven to be of immense benefit to vast numbers of people who experience psychotic symptoms as a component of a diverse group of neuropsychiatric and medical disorders, as well as drug-induced psychoses. These drugs have been invaluable in providing clues to the aetiology of schizophrenia and other forms of mental illness with psychotic features and as tools in understanding fundamental neural processes, especially those involving dopamine, a key neurotransmitter involved in psychosis. This class of drugs has now been supplanted by the so-called atypical antipsychotic drugs, of which clozapine is the prototype. This chapter will describe the various classes of antipsychotic agents, with emphasis on the atypical antipsychotic drugs, their benefits and adverse effects, recommendations for use in clinical practice, and mechanism of action. The drugs used to treat the extrapyramidal side-effects (EPS) produced mainly by the typical antipsychotic drugs are also considered.

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