Antipsychotics are a class of medications used to treat mental disorders characterized primarily by psychosis, delusions, and hallucinations. Their core function is to regulate the imbalance of neurotransmitters such as dopamine and serotonin in the brain, thereby alleviating psychotic symptoms. These medications are commonly used in the treatment of schizophrenia, manic episodes in bipolar disorder, and severe depression with psychotic features.
The treatment goal is not only to control acute symptoms but also to focus on long-term use to prevent relapse. Physicians select appropriate medication types and dosages based on the severity of symptoms, age, physical condition, and regularly monitor treatment response and side effects.
Antipsychotics are mainly divided into first-generation antipsychotics (typical antipsychotics) and second-generation antipsychotics (atypical antipsychotics). First-generation drugs primarily block dopamine D2 receptors, while second-generation drugs modulate both dopamine and serotonin receptors, potentially reducing the risk of certain movement disorders.
Newer medications may include 5-HT2A receptor antagonism to balance side effects and efficacy, but attention should be paid to the risk-benefit profile of different drugs.
Main indications include:
In specific cases, they may also be used to treat severe behavioral problems in autistic patients or as adjuncts in treating anxiety disorders. However, strict adherence to approved indications is necessary.
Oral medications are usually taken once or twice daily, while long-acting injections are administered every 2-4 weeks. Initial doses are adjusted based on age, liver and kidney function, with elderly patients typically starting at 20-30% lower doses.
Close observation during the initial treatment phase is essential to assess symptom improvement and side effects. Dosages may be gradually adjusted over 2-4 weeks to reach therapeutic levels. Self-discontinuation or dose reduction can lead to symptom relapse; adjustments should be made under medical supervision.
Main therapeutic effects include:
Long-acting injectables can improve medication adherence and reduce relapse caused by missed doses. Some drugs also provide rapid relief of manic symptoms in bipolar disorder.
Common side effects include:
Serious side effects requiring immediate medical attention: Neuroleptic malignant syndrome (high fever, muscle rigidity), QT prolongation leading to arrhythmias, tardive dyskinesia (involuntary movements), and other long-term movement disorders.
Contraindications include:
During use, regular monitoring is necessary:
Combining with anticonvulsants may increase sedative effects; using with β-blockers may induce hypotension. Co-administration with warfarin can enhance anticoagulant effects.
Using with anticholinergic drugs (such as certain antidiarrheals) may worsen side effects like dry mouth and urinary retention. When used with antiarrhythmic drugs, close ECG monitoring of QT interval is required.
Clinical trials show that second-generation drugs have a remission rate of approximately 60-70% for positive symptoms of acute schizophrenia, while first-generation drugs have similar efficacy in controlling hallucinations and delusions but carry a higher risk of movement disorders. In bipolar mania treatment, drugs like Olanzapine and Quetiapine have been shown to shorten hospitalization duration.
Long-term follow-up studies indicate that regular use can reduce relapse rates by 50-60%. However, patients with poor medication adherence often experience a significant decline in efficacy.
Non-pharmacological treatments include:
In specific situations, anxiolytics or antidepressants may be used as adjuncts but cannot replace the primary efficacy of antipsychotics.
What preparations or examinations are needed before starting antipsychotic treatment?
Before initiating treatment, doctors usually arrange blood tests, ECG, and liver function tests to assess the patient’s tolerance to the medication. Additionally, a detailed history and medication record are taken, especially regarding any heart disease or metabolic issues, which help in selecting the most suitable drug type and dosage.
How can I effectively manage weight gain caused by antipsychotic medications?
Weight gain is a common side effect. Patients are advised to monitor their weight and blood lipid levels regularly and develop a low-sugar, low-fat diet plan. Moderate aerobic exercise (such as brisk walking or swimming) can improve metabolism, but should be avoided immediately after taking medication to prevent absorption issues. If necessary, doctors may adjust the drug type or combine metabolic syndrome management strategies.
Can other prescription drugs or Chinese medicine be used simultaneously during treatment?
Antipsychotics may interact with certain drugs (such as antidepressants or antihypertensives). It is essential to inform your doctor of all medications being used, including Chinese medicine and over-the-counter drugs. Some herbal ingredients may affect liver enzymes, leading to abnormal drug concentrations, so professional assessment is necessary before combined use.
How long does it usually take for medication to take effect after an acute episode?
The onset of action varies; acute symptoms like hallucinations and delusions may improve within 2 to 4 weeks, but the full treatment cycle often lasts several months to years. Doctors will gradually adjust the dosage based on symptom stability and social functioning recovery. Patients should not stop medication on their own to avoid relapse.
How can long-term users of antipsychotics prevent tardive dyskinesia?
Prevention of tardive dyskinesia, associated with long-term dopamine antagonist use, relies on regular movement disorder assessments. Doctors may choose lower doses or second-generation drugs to reduce risk. Patients should avoid sudden discontinuation and maintain regular muscle endurance training. If involuntary movements occur, report immediately to the healthcare team for treatment adjustment.
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