1. ADR
   1. MOA
   2. PREVALENCE
   3. RELATIVE EFFECTS
   4. TREATMENT
   5. SYMPTOMS
   6. NB
2. DYSTONIA
   1. Oculogyric crisis, torticollis
   2. 10% with typicals
   3. Anticholenergics (AC)
   4. more likely in early stages, inc dose, may occur on withdrawal
   5. Less with atypicals
3. PSEUDOPARKINSONISM
   1. Bradykinesia, tremors, rigidity
   2. 20% with typicals
   3. AC (NOT D agonists)
   4. ACs have ADR, can be abused for street value
   5. as above
4. AKATHESIA
   1. subjective unpleasent state of motor restlessness -->anxiety, dysphoria
   2. 20-25% with typicals
   3. Propranolol, Cyproheptidine (anti-hista)
   4. Try atypicals
   5. Poor response with AC
   6. LINKED TO VIOLENCE AND SUICIDE
   7. as above
   8. Good: QUET, OLANZ
5. TARDIVE DYSKINESIA
   1. Supersensitivity to D receptors
   2. GABA pathways
   3. ~20% , typicals
   4. STOP/ REDUCE AC, dec AP dose, try atypicals
   5. CLOZAPINE- MAY TREAT IT!
   6. TETRABENAZINE IS THE ONLY LICENCED RX IN UK
   7. HIGH RISK GROUP: affective illness, DM, LD, women, elderly
   8. as above
6. HYPERPROLACTINEMIA
   1. Prolactin is under inhibitory control of Dopamine
   2. GOOD : CLOZ, OLANZ, QUET, ARIP, ZIPRA
   3. galactorrhoea, amenorrhoea, gynecomastia, hypogonadism, sexual dysfn, inc risk of osteoporosis
   4. x9 inc risk of BREAST CANCER
   5. SWITCH to non-pro drugs
   6. ~dopamine agonists (may worsen psychosis)
   7. BAD : RISP, AMISULP, ZOTEPINE
7. REDUCED SEIZURE THRESHOLD
   1. GOOD: SULP, TFP, HALO
   2. BAD :CLOZAPINE
   3. The more sedative and less potent drugs carry a higher risk than the more potent, less sedative drug
   4. 4-5% with CLOZ
8. POSTURAL HYPO
   1. Adrenergic alpha-1 blockade
   2. BAD : CLOZ, RISP, QUET, SERTINDOLE (so titrate doses)
9. ANTICHOLENERGIC EFFECTS
   1. dry mouth, constipation, uri retention, blurred vision, cog impair
   2. BAD :CLOZAPINE
   3. GOOD: HALO, SULP, TFP
10. NMS
    1. Rapid blockade of hypothalamic and straital dopamine receptors --> resetting of thermoreg systems
    2. 0.5% in FGAs
    3. Mortality - 20%
    4. All antipsychotics, Lithium, SSRIs, MAOI, TCA
    5. WORST - HALO
    6. mild HYPERthermia, fluctiating conc, muscular rigidity, autonomic instability, severe EPSEs,
    7. Raised serum CPK, Leucocytosis (WITH LEFT SHIFT), abnormal LFTs
    8. MAU- wITHdraw AP, monitor, rehydrate, sedate with benzo
    9. BROMOCRIPTINE + DANDROLENE
11. WEIGHT GAIN
    1. Insulin resistance, hyperprotactenemia, inc serum leptin
    2. 5-HT 2c and H1 blockade
    3. BAD: CLOZ, OLANZ, ZOTE
    4. GOOD: ARIP, AMISULP, HALO, TFP, ZIPRA
    5. OK: QUET, RISP, CPZ
    6. Switch
    7. Amantadine, bupropion, orlistat, etc
12. QT prolongation
    1. High effect - HALO
    2. No effect- ARIP
    3. LOW EFFECT - AMISULP, CLOZ, OLANZ, RISP, SULP
    4. Mod effect- QUET, ZOTEP
    5. QTc <440,M AND <470, F --> NO Action reqd
    6. QTc >440,m ,>470, f but <500 --> ECG, switch, cardiologist
    7. QTC >500 --> sTOP, Switch, Cardio ref immidiately
13. DM, IGT
    1. Insulin resistance, hyperglycemia, IGT, DKA
    2. ~1/3rd may develop DM after 2 yrs of Rx
    3. GOOD: AMISULP, ARIP, ZIPRA
    4. BAD :CLOZ> OLANZ > RISP > QUET
    5. Schizo itself is asso with DM
    6. OGTT IS THE MOST SENSITIVE Ix
    7. P Is 2-3 times the general pop
14. Dyslipedemia
    1. OLANZ IS THE WORST
    2. Inc TG AND LDL and dec HDL
    3. THEN CLOZ, RISP AND QUET
    4. ARIP AND HALO - ALMOST NONE
    5. Monitor- Fasting lipids at baseline, then every 3 mth for a yr,then annually
15. Sexual dysfunction
    1. Dec dopaminergic trans, hyperprolactin, sedation , wt gain, anti-cholinergic effect
    2. 45% on typicals
    3. OLAZ- LESS
    4. Subtopic 4
       1. RISP- Retrograde ejac, Inc prolactin, priapism
    5. QUET, CLOZ- ~low
    6. ARIP- ~none
    7. Topic
    8. Bromocriptine, amantadine - for hyperprolactin
    9. Alprostadil, sildenafil - for erectile dysfn
    10. Bethanecol for AC effects
16. Hyponatremia
    1. Water intoxication (sec to fluid overload)
    2. SIADH
    3. Pseudohyponatremia sue to hyperlipedemia, hyperglycemia
    4. 5%
    5. 11%
    6. All are implicated but least with CLozapine
    7. Fluid restriction, try Clozapine
    8. Demeclocycline for SIADH