Antipsychotics

• The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) is used to monitor antipsychotic side effects:

  • EPSE
  • Autonomic
  • Psychiatric
  • Anticholinergic
  • Allergic reaction
  • Prolactin
• The dopamine antagonist hypothesis of 1st generation antipsychotic drug action is that blocking the action of dopamine at the receptors in the mesolimbic pathway produces an effect on positive psychotic symptoms
• Blockade of dopamine receptors in the nigrostriatal pathway (typically 1st generation antipsychotics as non-specific) leads to movement disorders similar to Parkinson's disease

  The nigrostriatal pathway extends into the extrapyramidal system of the CNS - causes extrapyramidal side effects
• General side effects:

  • Sedation
  • EPSEs
  • Metabolic syndrome
  • Sexual dysfunction
• Specific side effects:

  • Clozapine - neutropenia, agranulocytosis
  • Risperidone - gynaecomastia and galactorrhoea
• General monitoring:

  • Before started - weight, waist circumference, blood pressure, bloods, ECG
  • Bloods - FBC, U&Es, LFTs, HbA1c, lipids
  • These will then be monitored regularly throughout treatment
  • Some antipsychotics require monitoring of prolactin concentration at the start of therapy, at 6 months and then yearly
  • Creatinine kinase is neuroleptic malignant syndrome is suspected