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Chapter 5.3 - Drug Treatment of the Psychoses

Published online by Cambridge University Press:  04 April 2024

By
Jonathan Rogers ,
Edward Chesney ,
Paul Morrison  and
Fiona Gaughran
Edited by
David Kingdon ,
Paul Rowlands  and
George Stein
David Kingdon
Affiliation:
University of Southampton
Paul Rowlands
Affiliation:
Derbyshire Healthcare NHS foundation Trust
George Stein
Affiliation:
Emeritus of the Princess Royal University Hospital
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Summary

The chapter describes the history, mechanisms and phases of drug treatment of antipsychotics including at-risk mental states (ARMS), first-episode psychosis (FEP), maintenance, treatment-resistant schizophrenia (TRS) and ultra-resistant psychosis. Specific treatments of schizoaffective disorder, catatonia and affective comorbidities of psychosis target negative symptoms and cognition. Rapid tranquilisation is described: general principles, de-escalation, routes of administration and medication selection. Management of organic psychotic disorders is discussed: general principles and specific conditions, epilepsy, Huntington’s, stroke, drug-induced, autoimmune encephalitis, inflammatory, CNS infections, thyroid disorders and traumatic brain injury. Side effects are elaborated: somnolence and sedation; hyperprolactinaemia and sexual dysfunction; motor, cardiac, metabolic and anticholinergic side effects; and also diabetes and impaired glucose tolerance and clozapine-specific side effects. Finally, potential drug interactions are explored.

Keywords

psychosisantipsychoticsmechanismsphases of treatmentat-risk mental statesfirst-episode psychosistreatment-resistant schizophreniarapid tranquilisationcatatoniaorganic psychotic disordersdrug interactions
Type
Chapter
Information
Seminars in General Adult Psychiatry , pp. 241 - 281
Publisher: Cambridge University Press
Print publication year: 2024

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