Chapter 20: Antipsychotic Medications

The content contrasts first-generation and second-generation antipsychotics, explaining how first-generation agents work primarily through dopamine receptor antagonism to reduce positive symptoms such as hallucinations and delusions, while second-generation medications provide broader neurochemical effects by targeting both dopamine and serotonin receptors, often with improved tolerability profiles. The dopamine hypothesis of schizophrenia serves as the foundational framework for understanding antipsychotic action, proposing that excessive dopaminergic signaling in specific brain regions contributes to psychotic symptomatology. The chapter addresses critical adverse effects associated with antipsychotic use, including extrapyramidal symptoms that result from dopamine blockade in motor pathways, the serious long-term complication of tardive dyskinesia characterized by involuntary movements, and metabolic consequences such as weight gain and glucose dysregulation. Individual antipsychotic agents including clozapine, risperidone, and aripiprazole are examined for their distinct pharmacological profiles and clinical advantages. The content also incorporates discussion of complementary and alternative medicine, reviewing common herbal supplements and dietary compounds used alongside or instead of conventional psychiatric medications. Critical attention is given to potential drug interactions between herbal remedies and psychiatric medications, with specific examples illustrating how certain supplements can reduce medication efficacy or increase adverse effects. The chapter emphasizes the necessity for ongoing clinical monitoring through laboratory assessments to detect metabolic changes and other emerging complications, while stressing the importance of patient education regarding medication adherence, realistic expectations for symptom improvement, and recognition of concerning side effects requiring medical attention.