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
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.
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 D2 receptor and tend to be more
selective in their pharmacologic effects ...