Pharmacotherapy for schizophrenia: Side effect management
- Stephen Marder, MD
Stephen Marder, MD
- Section Editor — Psychotic Disorders
- Professor of Psychiatry
- Semel Institute of Neuroscience at UCLA
- T. Scott Stroup, MD, MPH
T. Scott Stroup, MD, MPH
- Professor of Psychiatry
- Columbia University
Schizophrenia is a severe disorder involving chronic or recurrent psychosis and long-term deterioration in functioning . It is among the most disabling and economically catastrophic disorders, ranked by the World Health Organization as one of the top 10 illnesses contributing to the global burden of disease .
Antipsychotic medications are first-line medication treatment for schizophrenia. They effectively reduce symptoms and behaviors associated with the disorder and also have significant side effects. Some of the side effects differ in likelihood and/or intensity across individual antipsychotic drugs (table 1).
This topic addresses the management of side effects during pharmacotherapy for schizophrenia. Pharmacotherapy for schizophrenia is reviewed separately. Side effects of individual medications are also reviewed separately for first-generation antipsychotic drugs, second-generation antipsychotic drugs, and for clozapine. (See "Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment" and "First-generation antipsychotic medications: Pharmacology, administration, and comparative side effects", section on 'Side effects' and "Second-generation antipsychotic medications: Pharmacology, administration, and side effects", section on 'Side effects' and "Guidelines for prescribing clozapine in schizophrenia", section on 'Adverse effects'.)
Patients receiving an antipsychotic should receive routine monitoring for manifestations of extrapyramidal symptoms (EPS), including akathisia, parkinsonism, and dystonias. All of the antipsychotic medications have the potential for causing EPS. They are common with some antipsychotics (eg, haloperidol, fluphenazine, thiothixene, and trifluoperazine), and uncommon with others (quetiapine, clozapine, and iloperidone).
Akathisia — Akathisia is the most common form of EPS. It usually presents as motor restlessness with a compelling urge to move and an inability to sit still. Individuals with milder akathisia may describe a subjective feeling of restlessness but not show restless motor behavior. If patients do not demonstrate restless behaviors, the examiner should inquire if they pace frequently or if they have difficulty sitting still.
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- EXTRAPYRAMIDAL SYMPTOMS
- Parkinsonian syndrome
- TARDIVE DYSKINESIA
- METABOLIC SIDE EFFECTS
- Clinical management
- - Behavioral weight loss interventions
- - Metformin
- PROLACTIN ELEVATION
- OTHER SIDE EFFECTS
- Orthostatic hypotension
- Neuroleptic malignant syndrome
- QT prolongation
- Sudden death
- Anticholinergic effects
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS