Compare and contrast the use of conventional Antipsychotics therapy with Atypical Antipsychotics Therapy
Comparisons:
1. Efficacy in Treating Positive Symptoms: Both conventional and atypical antipsychotics have demonstrated efficacy in alleviating positive symptoms of schizophrenia (Lehne (2019, p. 331).
2. Mechanism of Action: "According to Lehne (2019, p. 331), both classes of antipsychotics exert their primary effects through the modulation of dopamine receptors, with conventional antipsychotics predominantly targeting D2 receptors.’’
3. Use in Schizophrenia: "According to Katzung, Trevor, & Author (2017, p. 495), both conventional and atypical antipsychotics are commonly employed in the management of schizophrenia and related psychotic disorders.’’
4. Individualized Treatment: The choice of antipsychotic medication should be individualized based on patient-specific factors, including symptomatology and medical history (Katzung, Trevor, & Author (2017, p. 495).
5. Monitoring and Follow-Up: According to Katzung, Trevor, & Author (2017, p. 495), Regular monitoring and follow-up are essential for optimizing treatment outcomes with both types of antipsychotics.
6. Potential for Side Effects: Both conventional and atypical antipsychotics have the potential to cause side effects, which can vary in severity among individuals (Lehne (2019, p. 331).
7. Dopamine Receptor Affinity: According to Lehne (2019, p. 332), While both classes act on dopamine receptors, conventional antipsychotics have higher affinity for D2 receptors, whereas atypical antipsychotics have a broader receptor profile, including 5-HT2A serotonin receptors.
8. Extrapyramidal Symptoms (EPS): Both conventional and atypical antipscyhotics induce extrapyramidal symptoms but, conventional antipsychotics are more likely to induce extrapyramidal symptoms, including Parkinsonism, dystonia, and akathisia, compared to atypical antipsychotics (Katzung, Trevor, & Author (2017, p. 495).
9. Risk of Tardive Dyskinesia (TD): The risk of developing TD is higher with conventional antipsychotics and relatively lower with atypical antipsychotics (Katzung, Trevor, & Author (2017, p. 495).
10. Treatment Duration: Both types of antipsychotics may be prescribed for varying durations depending on the patient's response to treatment and symptom stability (Katzung, Trevor, & Author (2017, p. 495).
Contrasts:
1. Negative Symptoms: Atypical antipsychotics are generally more effective in alleviating negative symptoms of schizophrenia, such as social withdrawal and blunted affect, compared to conventional antipsychotics (Katzung, Trevor, & Author (2017, p. 497) .
2. Metabolic Side Effects: Atypical antipsychotics are associated with a higher risk of metabolic side effects, including weight gain, dyslipidemia, and an increased risk of diabetes, in contrast to conventional antipsychotics (Katzung, Trevor, & Author (2017, p. 498).
3. Anticholinergic Effects: Conventional antipsychotics are more likely to produce anticholinergic side effects like dry mouth and constipation than atypical antipsychotics (Katzung, Trevor, & Author (2017, p. 495).
4. Serotonin Receptors (5-HT2A): According to Lehne (2019, p. 331), Atypical antipsychotics, by acting on serotonin receptors (5-HT2A), have a broader receptor profile, which contributes to their efficacy against a wider range of symptoms (Lehne (2019, p. 331).
5. Risk of Neuroleptic Malignant Syndrome (NMS): While both types of antipsychotics carry a risk of NMS, this adverse event is relatively more common with conventional antipsychotics (Lehne (2019, p. 331).
6. Risk of Agranulocytosis: Conventional antipsychotics are associated with a higher risk of agranulocytosis compared to atypical antipsychotics (Lehne (2019, p. 331).
7. Prescribing Trends: In recent years, atypical antipsychotics have become the preferred firstline treatment choice due to their superior side effect profile and broader efficacy (Katzung, Trevor, & Author (2017, p. 498).
8. Patient Compliance: Atypical antipsychotics are often better tolerated by patients, leading to improved compliance with treatment regimens compared to conventional antipsychotics (Katzung, Trevor, & Author (2017, p. 498).
9. Cost: Conventional antipsychotics are generally more affordable than atypical antipsychotics, which can be a consideration in healthcare settings (Katzung, Trevor, & Author (2017, p. 498).
10. Long-Term Outcomes: Long-term outcomes with atypical antipsychotics may be more favorable due to their reduced risk of severe movement disorders like TD and better control of symptoms ( Katzung, Trevor, & Author (2017, p. 498 ).
Qn 2.Discuss the side effects of treatment, patient compliance and long term outcomes. Conventional Antipsychotics: Side Effects of Treatment:
1. Extrapyramidal Symptoms (EPS): Conventional antipsychotics have a higher risk of causing EPS, including parkinsonism (tremors, muscle rigidity), dystonia (muscle spasms), and akathisia (restlessness) (Goodman & Gilman, 2017, p. 430). These can be distressing and uncomfortable for patients.
2. Tardive Dyskinesia (TD): Long-term use of conventional antipsychotics is associated with the development of TD, which is characterized by involuntary, repetitive movements of the face and limbs. TD can be irreversible in some cases (Goodman & Gilman, 2017, p. 430).
3. Anticholinergic Effects: Common side effects include dry mouth, constipation, blurred vision, urinary retention, and cognitive impairment. These effects can negatively impact a patient's quality of life (Goodman & Gilman, 2017, p. 434).
4. Neuroleptic Malignant Syndrome (NMS): Although rare, NMS is a potentially lifethreatening condition associated with conventional antipsychotics, characterized by fever, altered mental status, autonomic dysregulation, and muscle rigidity (Goodman & Gilman, 2017, p. 428).
Patient Compliance:
- Due to the uncomfortable and potentially serious side effects, some patients may be reluctant to comply with treatment, especially if they experience EPS or fear developing TD (Goodman & Gilman, 2017, p. 429).
Long-Term Outcomes:
- Long-term use of conventional antipsychotics may increase the risk of developing TD and other movement disorders (Goodman & Gilman, 2017, p. 432). - Some patients may experience persistent negative symptoms and cognitive impairment despite symptom control (Goodman & Gilman, 2017, p. 429). - Due to the side effect profile, long-term adherence can be challenging, potentially leading to relapse (Goodman & Gilman, 2017, p. 428).
Atypical Antipsychotics:
Side Effects of Treatment:
1. Metabolic Side Effects: Atypical antipsychotics are associated with an increased risk of weight gain, dyslipidemia, and an elevated risk of diabetes. Monitoring for these metabolic effects is crucial( Katzung, Trevor, & Author (2017, p. 498 ).
2. Sedation: Some atypical antipsychotics can cause sedation, which may affect a patient's daily functioning( Katzung, Trevor, & Author (2017, p. 497 )..
3. Orthostatic Hypotension: A drop in blood pressure upon standing can occur with some atypical antipsychotics, leading to dizziness or falls( Katzung, Trevor, & Author (2017, p. 496).
4. Anticholinergic Effects: Similar to conventional antipsychotics, some atypical antipsychotics can cause dry mouth and constipation, but these effects may be less severe( Katzung, Trevor, & Author (2017, p. 495).
Patient Compliance:
- Atypical antipsychotics are often better tolerated in terms of extrapyramidal symptoms and tardive dyskinesia, which can improve patient compliance with treatment.
Long-Term Outcomes:
- Atypical antipsychotics may offer improved long-term outcomes due to their broader efficacy, including better control of both positive and negative symptoms( Katzung, Trevor, & Author (2017, p. 494 ). - Lower risk of severe movement disorders like TD is a significant advantage (Katzung, Trevor, & Author (2017, p. 497). - Improved patient compliance may lead to better symptom management and overall outcomes (Katzung, Trevor, & Author (2017, p. 496).
In summary, atypical antipsychotics are generally preferred over conventional antipsychotics due to their more favorable side effect profile and broader efficacy. However, both types of antipsychotics have their advantages and disadvantages, and the choice of medication should be individualized based on the patient's specific needs, medical history, and side effect tolerance. Long-term outcomes depend on factors like medication adherence, monitoring, and addressing potential side effects.
REFERENCES i)Lehne, R. A. (2019). Lehne's Pharmacology for Nursing Care (10th ed.). Elsevier. ii) Katzung, B. G., Trevor, A. J., & Author(s), if applicable. (2017). Basic and Clinical Pharmacology (14th ed.). McGraw-Hill. iii) Goodman, L. S., & Gilman, A. G. (Eds.). (2017). "Goodman & Gilman's The Pharmacological Basis of Therapeutics" (13th ed.). McGraw-Hill Education.