Polypharmacy Essential Concepts Polypharmacy is a fuzzy concept since, at the molecular level, antipsychotic monotherapy constitutes intrinsic polypharmacy. Appropriate reasons for combination treatments are as follows: added efficacy, supplemental symptom…
Drug Interactions Essential Concepts All antipsychotics are metabolized to varying degrees by the hepatic cytochrome P450 (CYP450) isoenzymes 3A4, 2D6, and 1A2. Some have additional non-P450 metabolism, which lowers the…
Ancillary Medications Essential Concepts Avoid antidepressants during acute episodes of psychosis, but consider antidepressants in patients with remitted schizophrenia who develop full, syndromal depression. Valproate is useful adjunctively in acute…
Antipsychotics—Nonmotor Side Effects Essential Concepts Nonmotor side effects of antipsychotics, such as sedation or weight gain, can reduce quality of life and lead to nonadherence. Metabolic side effects (i.e., diabetes…
Antipsychotics—Motor Side Effects Essential Concepts Motor side effects associated with antipsychotic treatment include acute extrapyramidal syndromes (acute dystonic reaction, akathisia, parkinsonism) and long-term complications [tardive dyskinesia (TD)]. The sine qua…
Antipsychotics—Overview Essential Concepts All antipsychotics share varying degrees of dopamine-2 (D2) blockade as the presumed main mechanism of action. Primary symptom targets of antipsychotics are positive symptoms (disorganization, delusions, and…
Phase-Specific Treatment of Schizophrenia Essential Concepts Treatment during the three stages of illness (i.e., acute, stabilization, and stable maintenance phase) tries to achieve symptom response, symptom resolution, and symptom remission…
Emergency Management of Acute Psychosis Essential Concepts During all steps of the emergency evaluation of a psychotic patient, ensure the safety of the patient, staff, and other patients in the…
Diagnosing Schizophrenia—Clinical Approach Essential Concepts Schizophrenia is a clinical diagnosis you can make if typical symptoms are present long enough and are severe enough in the absence of other causative…
Schizophrenia-Spectrum Disorders Essential Concepts Schizophrenia-spectrum disorders are characterized by prominent psychotic symptoms not explained by medical illness or drugs. Schizophrenia is a clinical diagnosis based on a combination of characteristic…
