Atypical antipsychotics counselling

Question 1

Check for contraindications

Answer 1

• Hepatic impairment
• Phaeochromocytoma

Question 2

How the treatment works

Answer 2

• Schizophrenia is thought to be caused by problems with dopamine receptors in your brain
• Atypical antipsychotics work by blocking these receptors

Question 3

Treatment course and how it’s taken

Answer 3

• Tablet injection or depot injection every 2-4 weeks
• Dose built up over a week or two
• Dose adjusted depending on response
• Can take several days or weeks to work

Question 4

Monitoring required

Answer 4

• Before treatment, at 3 months, 12 months, then annually: pulse, BP, weight, waist circumference, ECG, HbA1C, fasting glucose, lipid profile, prolactin
• Weight checks weekly for 6 weeks

Question 5

Side effects

Answer 5

• Anti-dopaminergic (tardive dyskinesia, tremor, movement disorders)
• Anti-cholinergic (constipation, dry mouth)
• Anti-histaminergic (weight gain, dizziness, drowsiness)
• Anti-adrenergic (Hypotension)
• Neuroleptic malignant syndrome (high fever and muscle rigidity)
• Agranulocytosis (clozapine)
• Withdrawal
• Hyperglycaemia and diabetes
• Hyperprolactinaemia (sexual dysfunction, menstrual disturbance, galactorrhoea etc)
• Prolonged QT