Schizophrenia Side effects of anti-psychotic drugs

Side effects of anti-psychotic drugs

I-Extrapyramidal side effects:
It can be divided into the followings:
1-Dystonic reactions: these are sudden onset of spasm involving mainly the neck and upper trunk muscle so that the neck might be tilted or diverted in certain direction with oculogyric crisis ( in which the eyes are diverted upward ) this condition occur specially in high potency drug . Its considered as an emergency condition and must be treated immediately by :
1-either anticholinergic drug like procyclidine ( injection)
2- or a benzodiazepine ( if no response appears )
3-or IV ( Ca+2 compounds ) if no response of previous one appears
*then the patient has to continue on oral anticholinergic drugs.

2- Akathisia : this is called also restless leg or motor restlessness .

Here, the patient wanders inside the room without the desire to settle down.
He continues to walk around and around without stopping.
3- Parkinsonian syndrome (parkinsonism )
It is a reversible drug induced condition which differs from Parkinson disease which is an irreversible condition ( disorder ) characterized by failure of the substantia nigra to produce dopamine in enough quantity to the striate body .
Here the patient has the same feature of the Parkinson disease which are:
1-rigidity ( mainly)
2- Tremor (resting type )
3- Shuffling gait
4-Loss of facial expression


4- Tardive dyskinesia
It is a movement disorder which is characterized by involuntary movement affecting mainly the face and tongue, and can involve trunk and limbs.
This disorder occurs due to long term usage of neuroleptics drug in chronic cases and is usually irreversible.
It involves movement of face like mastication , chewing, sucking, other involuntary movements of the head , neck and upper trunk.
Note : this disabling condition occur due to damage of D1 dopamine receptors.
II- Malignant neuroleptic syndrome
This is a medical emergency condition and requires immediate intervention because it is life threating .
If the patient is not treated urgently it may lead to death .
It occurs at the beginning of treatment course with high potency drugs but may occur by use of others drugs
The syndrome is characterized by the fellowing feature
1-hypertension
2- pyrexia ( hperthermia)
3- hyper reflexia
4- agitation
These features ( high blood pressure , fever, distorted behaviore) must be treated by
1-Addmision of the patient to the hospital
2- Resuscitation
3- Correction of fluid and electrolyte disturbance
4-Stopping the drug
5- Giving the drug that antagonize the effect of dopamine ( bromcreptine or the drug that reduce the muscle metabolism ( contraction ) leading to decrease body temp. ( dantrolene ) which reduce the release of intracellular Ca. ion .
N.B
Breakdown of the muscle fiber increase plasma creatinine kinase C- PCKa
III - Anticholinergic S.E .
These symptoms are
1-dry mouth
2- high blood pressure
3- tachycardia
4- cycloplegic ( loss of accommodation ) blurred vision it means calliary body
5- constipation
6- retention of urine
7- cardiac disturbance
8- increase IOP, so it is contraindicated in glaucoma
9- visual disturbance


IV - adrenergic S.E.
There are neuroleptic postural hypotension , impotence , loss of libido.
V- over-sedation:
This occurs usually by the use of low potency drugs in which drowsiness is observed but doesn't occur in high potency drugs but sedation usually decrease with continuing the use of drugs
VI- Biochemical side effects ( metabolic )
- weight gain
- increase appetite
- increase secretion of prolactine hormone which leads to sexual dysfunction- galctorrhea ( lactation ) in no relation with pregnancy , amenorhea , menstural disturbance , gyneacomastia . ETC .

Note: NL especially thioridicone »» disturbance in hear conduction » death

NL especially thioridazine cause chocking lead to death
NL are contraindicate in children

VII- Skin reactions (Hypersensitivity reaction ) allergic reaction of skin occurs after exposure to sunlight ( photosensitive dermatitis ) has also been observed as a side effect.
Retinitis pigmentosa :pigmentary retinopathy has been described in long term use of thioridizaine .
Actually it is due to melanin pigmentation of the retina and may lead to complete blindness

VIII-blood dyscrasia (hypersensitivity reaction) :

Leukopenia and agranylocytsis are rare side effect but potentially fatal reaction which may occur in the first weeks of treatment
Clozapine is the most likely drug that causes agranylocytosis
And its use involve regular monitoring of blood parameters to be stopped by first sign of leukopenia and even anemia
Note- another hypersensitivity reaction is jaundice which is mild and obstructive type due to blockage of bile canaliculi by the precipitated material


Related conditions of schizophrenia
1- Schizopherniform disorders
The picture is similar to that of schizophrenia for the first four characteristic symptoms without the fifth one to be involve ( negative symptoms ) the duration is usually one to six month .
The patient with positive symptoms For 1-6 months has a good prognosis
Because the remission is usually expected before sixth month
The social and occupational deterioration is not observed and medical condition which may cause schizophrenic like symptoms for limited period of time must be excluded
2-Schizoeffective disorder :
This disorder characterized by mixture of schizophrenic symptoms and mood effective symptoms ( manic symptoms , depressive symptoms . Etc)
Which need at least four weeks to two years or more . That is to say four weeks of schizophrenic symptoms ( hallucination , and or delusion , etc )
combined with effective mood disorder symptoms (excitement - mania - depression . Etc ) must be present to mixed schizoeffective disorder and can continue for two years and more
3-Brief psychotic disorder one day to one month
This picture is of positive schizophrenic symptoms lasting from one day to one month with no occupational and social dysfunction or deterioration with exclusion of other conditions. The patient returns usually to normal state with a very good prognosis.
Note \ other psychotic and medical disorders must be excluded and also drugs ( ex . Hallucinogens) must be excluded.
4- Shared or induced psychosis
Here the patient become schizophrenic because he lives with a schizophrenic person or has a close contact with a schizophrenic friend . He gains the schizophrenic feature involuntary by his close relationship with original patient. The example of close relationship is that between the mother and her daughter . The condition is treated by separation of the two with specific treatment of both of them.
5- Medical condition induced psychosis: a certain medical condition may induce psychotic disorder for limited period of time after which symptoms disappear
6- Drug induced psychosis
The symptoms of psychotic disorder may appear due to either
1- Misuse of drug ( abuse ) 2- Withdrawal of drug
The symptoms that are induced are not related to drug directly , but occur due to change in neurotransmitters at the synapses .
Note / certain drug( with no misuse , abuse or withdrawal) may cause psychotic symptoms e.g- bromcripitine dopamine agonist
7- Delusion disorder
As we know a delusion is false belief of morbid origin, unshakable , and is not consistent with his culture or society . There are type of delusion ( primary ,secondary .etc ....) but we want to demonstrate only the following :
1- Bizarre delusion : here, the delusion cannot be believed e.g- a patient thinks that his that his bowel is inside the chest ( very strong believe )
2- Non bizarre delusion: here, the delusion can be believed by someone who doesn't know that the patient has delusion
Ex-someone has plan to kill me because i had ...... Etc .
Someone want to poison me because I had hurt him previously .
Now we come to specific type of delusion:-
1- delusion of persecution
2- grandiose delusion
3- etc


These 6 Printed Lectures were done By;
Saif AlDeen Adil
Khalid Jamal
Yusor Jaafar
Shadan Khorsheed
Moadh Moayad
Hasan Abd AlHadi