Chapter 22: Antipsychotics & Anxiolytics in Practice

Antipsychotics & Anxiolytics in Practice begins by establishing the neurobiological foundations of mental illness, where chemical messengers like dopamine, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) regulate mood, cognition, and emotional stability. A core focus is placed on the management of schizophrenia, a chronic disorder characterized by positive symptoms—such as hallucinations, delusions, and paranoia—and negative symptoms—including social withdrawal, blunted affect, and lack of motivation. The text categorizes neuroleptics into typical and atypical groups. Traditional typical antipsychotics, including phenothiazines and butyrophenones like haloperidol, primarily serve as dopamine antagonists to curb positive symptoms. However, these first-generation agents are frequently linked to extrapyramidal syndrome (EPS), which encompasses acute dystonia, akathisia, pseudoparkinsonism, and the potentially permanent involuntary movements of tardive dyskinesia. In contrast, atypical antipsychotics represent a newer therapeutic approach, targeting a broader range of receptors to treat both positive and negative symptoms with a reduced risk of motor side effects. Despite this advantage, second-generation agents require careful monitoring for metabolic issues, weight gain, and rare but serious blood disorders like agranulocytosis. The chapter also addresses the life-threatening risk of neuroleptic malignant syndrome (NMS), characterized by muscle rigidity and hyperthermia. Furthermore, the discussion transitions to anxiolytics, emphasizing how benzodiazepines like lorazepam and alprazolam potentiate the inhibitory effects of GABA to manage excessive anxiety, seizures, and withdrawal symptoms. The material highlights the clinical dangers of physical dependency, drug tolerance, and severe central nervous system depression, particularly when these agents are combined with alcohol or other depressants. Non-benzodiazepine alternatives like buspirone are explored for their unique receptor affinity and lower risk of addiction. Finally, the nursing process is integrated throughout, emphasizing the critical role of the healthcare provider in monitoring patient safety, performing vital sign assessments, managing medication adherence, and providing essential education regarding side effects, tapering schedules, and dietary restrictions.