Chapter 18

The antipsychotic agents, also known as neuroleptic drugs, are used in schizophrenia and are also effective in the treatment of some other psychoses and agitated states. Although schizophrenia is not cured by drug therapy, the symptoms, including thought disorder, emotional withdrawal, and hallucinations or delusions, may be ameliorated by antipsychotic drugs. Unfortunately, protracted therapy (years) is often needed and can result in severe toxicity in some patients.

In bipolar affective disorder, lithium has been the mainstay of treatment for many years. Recently, however, the use of newer antipsychotic agents and of several antiseizure drugs has been increasing.

The term psychosis denotes a variety of mental disorders. Schizophrenia is a particular kind of psychosis characterized mainly by a clear sensorium but a marked thinking disturbance. The pathogenesis of schizophrenia is unknown, although a genetic predisposition has been proposed that is based on the observed familial incidence of schizophrenia. The molecular basis of the disease is also unclear, but evidence suggests there is a link with abnormalities of amine neurotransmitter function, especially that of dopamine. For this reason, drug therapy for schizophrenia is directed at this group of neurotransmitters and their receptors.

Bipolar affective (manic-depressive) disorder is a frequently diagnosed and very serious psychiatric disorder characterized by cyclic attacks of mania with many symptoms of paranoid schizophrenia (grandiosity, bellicosity, paranoid thoughts, and overactivity) alternating with periods of severe depression.

Schizophrenia is by far the most common form of psychosis and although current drug therapy does not cure the disease, the number of patients requiring hospitalization in mental institutions has markedly decreased since the first neuroleptic drugs (reserpine and chlorpromazine) were found to be useful in the early 1950s. Because of the positive effects of drug therapy on the symptoms of the disease, psychiatric philosophy has shifted to a more biologic basis.

Physical therapists may encounter patients taking antipsychotic medications in several settings. Many psychiatric facilities employ therapists to provide direct care to their patients. Also, therapists may encounter patients outside the hospital setting, taking antipsychotic medications (Figure 18–1), who have been referred for rehabilitation for a diagnosis unrelated to their psychosis.

###### Figure 18–1.

Common drugs used to treat psychoses and bipolar disorders.

The major chemical subgroups of older antipsychoticdrugs are the phenothiazines (e.g., chlorpromazine, thioridazine, fluphenazine), the thioxanthenes (e.g., thiothixene), and the butyrophenones (e.g., haloperidol). Newer drugs (second-generation or atypical drugs) vary in their chemical structure but are also effective in schizophrenia. They include clozapine, loxapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. In some patients, these atypical drugs are more effective and less toxic than the older drugs. They are deemed atypical because they appear to have lower affinity for the dopamine D2receptor and tend to be more selective in ...

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