Treating Psychosis With Typical Antipsychotics: Understanding Their Role and Side Effects

Introduction to Typical Antipsychotics

Typical antipsychotics, also known as first-generation antipsychotics, are psychotropic medications primarily used to treat symptoms of psychosis, a mental state characterized by a loss of touch with reality and often accompanied by hallucinations and delusions. While they have been largely replaced by atypical antipsychotics in recent years, typical antipsychotics still play a significant role in managing certain mental health conditions.

Conditions Associated with Psychotic Episodes

Psychosis can be triggered by various psychiatric disorders and physical illnesses that affect brain function and behavior. Common mental health conditions linked to psychotic episodes include:

• Schizophrenia
• Schizoaffective Disorder
• Bipolar Disorder
• Delusional Disorder
• Brief Psychotic Disorder

Common physical conditions associated with psychosis include:

• Epilepsy
• Advanced HIV Infection
• Parkinson's Disease
• Stroke
• Brain Tumors
• Dementia
• Methamphetamine Abuse

Understanding Approved Typical Antipsychotics

Typical antipsychotics were first developed in the 1950s, and their use expanded to include conditions like acute mania, agitation, and severe mood disorders. These medications are generally divided into three potency levels: low, medium, and high.

Low-potency Typical Antipsychotics:

• Thorazine (Chlorpromazine)
• Truxal (Chlorprothixene) (not available in the U.S.)

Medium-potency Typical Antipsychotics:

• Loxitane (Loxapine)
• Navane (Thiothixene)
• Trilafon (Perphenazine)

High-potency Typical Antipsychotics:

• Clopixal (Zuclopenthixol) (not available in the U.S.)
• Compro (Prochlorperazine)
• Depixol (Flupentixol)
• Haldol (Haloperidol)
• Majeptil (Thioproperazine) (not available in the U.S.)
• Mellaril (Thioridazine)
• Prolixin (Fluphenazine)
• Stelazine (Trifluoperazine)

Side Effects of Antipsychotics

Typical antipsychotics can cause a range of side effects, which vary depending on the specific drugs or combinations used. Some side effects may be mild and transient, while others can develop over time and potentially lead to more severe outcomes.

Extrapyramidal Side Effects (EPS):

The most significant concern with typical antipsychotics is the risk of EPS, which affect body movement and speech. EPS can manifest in various forms, including acute dyskinesias, akathisia, and akinesia, as well as dystonic reactions and parkinsonism. In severe cases, tardive dyskinesia can develop, characterized by involuntary and repetitive facial movements.

Other Common Side Effects:

• Upset stomach
• Weight gain
• Dry mouth
• Blurry vision
• Constipation
• Vomiting
• Drowsiness
• Orthostatic hypotension (low blood pressure when standing)

Rare but Life-Threatening Reactions:

• Neuroleptic malignant syndrome: This rare but severe reaction can include high fever, muscle rigidity, altered mental state, and dysfunction of the autonomic nervous system.

Combination Therapy in Mental Illness Management

In managing mental illness, antipsychotics are often combined with other medications, such as mood stabilizers, antidepressants, and anti-anxiety drugs, to enhance treatment effectiveness. This approach aims to target multiple symptoms and improve overall outcomes.