Psychotic Syndromes

Antipsychotics (neuroleptics) can be used in patients with acute psychoses while a specific etiology is being sought ( .Table.3-4 ). Although some of these drugs are sedating, they have more specific effects on the thought and mood disorder. Many different agents are available including the phenothiazines, thioxanthenes, dibenzoxazepines, and butyrophenones. The acutely psychotic patient who is a danger to himself or others may be treated parenterally with intramuscular haloperidol (5 mg every hour over 4 hours) or chlorpromazine. In addition, oral doses of haloperidol (10 to 15 mg/day) or chlorpromazine (300 to 400 mg/day) or the equivalent should be started.

TABLE 3-4 -- COMMON ANTIPSYCHOTIC DRUGS AND DOSES

Generic (Trade) Names

Dosage Form and Range

Oral

Parenteral (IM)

PHENOTHIAZINES

Chlorpromazine (Thorazine)

200-800 mg/day

25-50 mg/dose

Fluphenazine (Prolixin)

Hydrochloride

2-20 mg/day

None

Enanthate/decanoate

None

1.25-2.5 mg every 1-4 weeks

Trifluoperazine hydrochloride

5-20 mg/day

1-20 mg/dose

THIOXANTHENES

Thiothixene hydrochloride (Navane)

5-30 mg/day

2-4 mg/dose

BUTYROPHENONE

Haloperidol (Haldol)

Hydrochloride

2-20 mg/day

2-5 mg/dose

Decanoate

None

25-250 mg every 2-4 weeks

HETEROCYCLICS

Clozapine (Clozaril)

6.25-900 mg/day

None

Risperidone (Risperdal)

2-8 mg/day

None

Olanzapine (Zyprexa)

10-15 mg/day

None

Newer agents including clozapine, risperidone, and olanzapine may also be used. Anxiety and Obsessive-Compulsive Disorder Syndromes

In patients with chronic mild or moderately severe anxiety, benzodiazepines, used sparingly for a few weeks to several months, can be helpful. When chronic treatment is necessary, buspirone, tricyclic antidepressants, and MAO inhibitors may be utilized in selected patients, particularly those with concomitant depression. Beta-blockers may also be useful in certain cases. Referral to a neuropsychologist or psychotherapist for training in self-reliance and relaxation techniques including biofeedback, meditation, and self-hypnosis should also be considered. The treatment of obsessive compulsive disorders should involve both pharmacological and psychological measures. Medications can significantly reduce the symptoms in over 50 percent of patients. Clomipramine is generally considered the drug of first choice, but other drugs with serotonergic properties such as fluoxetine, paroxetine, and clonazepam can be used.

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