Chapter 14: Antipsychotic Drugs: Uses & Effects

Antipsychotic Drugs: Uses & Effects traces the history of these medications from the discovery of chlorpromazine in the 1950s to the development of modern atypical agents, classifying them into first-generation (traditional) and second-generation (atypical) categories. The text explores the neurochemical theory of schizophrenia, focusing on the dopamine hypothesis and the role of four major dopaminergic tracts—mesolimbic, mesocortical, nigrostriatal, and tuberoinfundibular—in mediating both therapeutic effects and adverse reactions. Detailed explanations are provided regarding the mechanism of action, where traditional agents primarily block dopamine D2 receptors to reduce positive symptoms like hallucinations and delusions, often at the cost of causing extrapyramidal side effects (EPSEs) such as akathisia, dystonia, parkinsonism, and tardive dyskinesia. The chapter contrasts this with atypical antipsychotics, which utilize serotonin antagonism to mitigate motor side effects and address negative symptoms, though they carry risks for metabolic syndrome and weight gain. Critical safety issues are highlighted, including the life-threatening neuroleptic malignant syndrome (NMS), agranulocytosis associated with clozapine, and QT prolongation. Furthermore, the summary covers pharmacokinetics, the utility of long-acting injectable formulations for improving adherence, and specific nursing implications for assessment and patient education regarding these potent psychotropic medications.