Chapter 22: Psychotherapeutic Agents

Modern understanding suggests these conditions stem from inherent dysfunction or chemical imbalances within the brain. The major pharmacological categories include Antipsychotic/Neuroleptic Drugs, Drugs for Bipolar Disorders, and Central Nervous System (CNS) Stimulants. Antipsychotics, which are used to treat psychoses like schizophrenia, are classified as either typical (dopamine receptor blockers, e.g., chlorpromazine) or atypical (dual dopamine and serotonin receptor blockers, e.g., clozapine). Nursing care for antipsychotics requires intense monitoring for severe neurological adverse effects, collectively known as extrapyramidal symptoms, which include dystonia, akathisia, pseudoparkinsonism, and potentially irreversible tardive dyskinesia. Furthermore, caution is mandated due to cardiovascular risks, such as hypotension and QTc interval prolongation, and these drugs carry a black box warning against their use in elderly patients with dementia for behavior control, owing to increased risk of cardiovascular events and death. Treatment for bipolar disorder often relies on lithium, a standard antimanic agent and membrane stabilizer that requires scrupulous serum level monitoring (target 0.6 to 1.2 mEq/L) as it is a potentially toxic salt, requiring patients to maintain consistent hydration and salt intake to prevent dangerous toxicity. Finally, CNS stimulants, such as methylphenidate, paradoxically help calm hyperkinetic children with ADHD or improve wakefulness in narcolepsy by stimulating the reticular activating system (RAS) and increasing catecholamine release. Given the risk of sudden cardiac death associated with stimulants, children should receive a baseline electrocardiogram (ECG) before starting therapy, and ongoing monitoring is necessary for cardiovascular effects and dependence, as many CNS stimulants are controlled substances.