Antipsychotics actually help

Neuroleptics

Neuroleptics (Antipsychotics) “organize” the disturbed psychological functions. They are mainly used to treat psychoses with delusions and hallucinations (especially schizophrenia) and for severe disorders of thought and experience in the short, medium or long term.

Furthermore, neuroleptics are used to calm acutely confused patients and to treat delusional depression and - which is sometimes controversial - other serious mental illnesses.

The antipsychotic effect of neuroleptics opens the patient up to psychotherapy on the one hand, and on the other hand they have a calming and dampening effect depending on the type and dosage.

Contrary to a widespread prejudice, neuroleptics also work for a very long period of time Not addicting, but sometimes have strong side effects. The antipsychotic effectiveness correlates with a - more or less pronounced - undesirable impairment of the motor function (extrapyramidal motor side effects).

As typical neuroleptics are called neuroleptics of the first generation. A distinction is made between low-potency, medium-potency and high-potency neuroleptics according to the strength of their effect and the side effect profile. Highly potent neuroleptics are most effective against psychotic symptoms, but are only slightly calming. They have comparatively strong side effects. In the case of low-potency neuroleptics, on the other hand, the calming, sedating effect is in the foreground with only weak extrapyramidal motor side effects.

As atypical neuroleptics (Atypicals) are modern neuroleptics which, compared to typical neuroleptics, impair the motor skills and the ability to think and perceive the patient less and are said to have weaker extrapyramidal motor side effects. However, the latter is being called into question by new studies and only applies without restriction to clozapine (Leponex®). A US study from March 2009 found that the atypicals doubled the risk of sudden cardiac death. The risk increases with the dose taken. The advantages and disadvantages of atypical neuroleptics are currently being discussed controversially, so that when choosing a suitable neuroleptic, the focus should be on individual tolerance.

Most neuroleptics are taken as tablets in 1–2 doses a day. Some neuroleptics can also be administered as depot medication: They are injected into the muscle tissue and continuously release the active ingredient into the bloodstream for up to four weeks. This is an advantage for outpatients who often forget to take their medication. On the other hand, side effects that may occur are difficult to stop with depot medication.

Side effects. At the beginning of drug treatment with neuroleptics, some patients experience sleepiness, restlessness, muscle twitching, dizziness, thirst and dry mouth. There are effective drugs against the latter, such as artificial saliva. A weight gain of ten or more kilograms is also a burden. It is based on the fact that neuroleptics lower the basic metabolism, but not the appetite. This is especially true for clozapine and olanzapine.

Furthermore, many patients are very annoyed that the neuroleptics can influence the range of motion. Of these extrapyramidal motor side effects Both the "fine motor skills" and the "rough" movement sequences are affected. Many patients experience this undesirable effect, for example, as sitting restlessness. In this so-called Akathisia If the patient can no longer sit still, he walks around restlessly and feels great restlessness. Other extrapyramidal motor side effects are muscle stiffness, hand tremors and - similar to Parkinson's disease - a stiff, small-step gait (drug-induced Parkinson's syndrome).

Extrapyramidal motor side effects can be caused by certain medications such as B. Akineton® can be mitigated.

After prolonged therapy with neuroleptics, some patients experience problems such as B. specific bad posture (Dystonia) and incorrect movements (Early- or. Tardive dyskinesia) on. Affected stretch z. B. jerk your tongue out or make grimaces involuntarily.

The typical neuroleptics in particular influence the hormonal balance; in particular, they can stimulate the release of the hormone prolactin. The consequences are decreased sexual interest, impotence in men, leakage of fluid from the nipples in women and the absence of menstruation.

The calming effect that neuroleptics trigger at the start of therapy is generally desirable. However, many patients still feel extremely tired after the acclimatization phase, suffer from listlessness, lack of concentration or a bad mood.

A rare but dangerous side effect of olanzapine is DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms). This is a severe drug hypersensitivity reaction that usually occurs within eight weeks of starting treatment. Typical signs are a widespread skin rash and flu-like symptoms with fever and swelling of the lymph nodes. In the further course there is a risk of inflammation of the heart, lungs, liver or kidneys. Olanzapine users who develop skin rashes and / or flu-like symptoms shortly after starting treatment should have these checked out by a doctor immediately in order to rule out DRESS syndrome.

In view of the wide range of side effects, the question of choosing the right neuroleptic is of great importance - because this allows the undesirable effects to be clearly narrowed down in individual cases. Unfortunately, there are currently no generally accepted guidelines; experts only agree that the aspect of the patient's quality of life must be in the foreground.

The unauthorized discontinuation of a neuroleptic is risky because the risk of relapse is very high. If the patient wants to change the drug or the dosage, he should always discuss this with his doctor. Family members should ensure that the tablets are actually taken if they are suspected. It is not uncommon for patients to try to collect the medication and then take their own life with an overdose.

Authors

Dr. med. Arne Schäffler, Gisela Finke in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 14:32