Patient Care and Monitoring

1. Assess the patient's symptoms, review patient and family history, and obtain initial medical evaluation to rule out other causes of psychosis.

2. Periodically review patient data for consistency with diagnostic criteria, and regularly monitor changes in symptomatology.

3. Obtain a thorough history of prescription medication use, and determine what treatments have been helpful in the past, which treatments the patient is currently receiving, and previous side effects experienced.

4. Determine whether the patient is taking an appropriate antipsychotic drug and dose and whether the patient has other symptoms that may need to be treated.

5. Educate the patient, and the family if possible, about the disease state, medication treatments, possible side effects, and goals of treatment.

6. Develop a plan to assess the effectiveness of the current treatment regimen. Also, consider alternative treatments if current treatment is ineffective.

7. Encourage a healthy lifestyle, including eliminating or decreasing substance abuse and cigarette use, as well as appropriate nutritional counseling and exercise suggestions.

8. Determine the role of psychosocial treatments.

9. Evaluate the patient for the presence of adverse drug reactions, drug interactions, and allergies.

10. Monitor the appropriate laboratory measures to prevent or minimize metabolic abnormalities and other side effects.

11. Stress the importance of adherence with the treatment regimen and maintain treatment even if the patient is feeling well.

Commonly used rating scales to monitor for EPS include the Simpson Angus Scale (SAS) and the Extrapyramidal Symptom Rating Scale (ESRS). Akathisia is commonly monitored by the Barnes Akathisia Scale (BAS). The emergence of dyskinesias (writhing or involuntary movements) could represent the emergence of TD. Monitor for TD at least annually, and if FGAs are used, patients should be evaluated at each visit. The most commonly used instrument to measure these symptoms is the Abnormal Involuntary Movement Scale (AIMS).

Abbreviations Introduced in This Chapter

!vHT Serotonin

AIMS Abnormal In voíu n ra ry Moví1 me rit Sea le

ANC Absolute neutrophil count

C ATI E CI in ica E A nt ípsyc tw >l ic s Tri als < í » it r vent iun

Effectiveness

CGI Clinical Global Impression Scale

CR Cognitive remediation

CYP45Ü Cytochrome P-45Û isoenzyme

D Dopamine

J ?SM-l V-TR Diagnostic und Statistical Mon uu I of Aft.1 mal

Disorders* 4th Edit Ion t lext Revision

HCT Elec I roconv u Isí ve i horapy

EPS Exl ra pyram id a I side effet [$

L5RS Extrapyramidal Symptom Rating Scale

FGA First-generation antipsychotic

H Histamine

IM

Intramuscular

M

Muscarinic

NM DA

N- me t h yl - d- a sp a r I a ec

NMS

Neuroleptic malignant syndrome

PCP

Phencydidine

PANSS

Positive and Negative Symptom Scale

PORT

Schizophrenia Patient Research Outcomes

Team

SAS

Simpson Angus Scale

SGA

Second - gene ru I ion antipsychotic

SSRI

Selective serotonin reuptake inhibitor

sst

SociaE skills training

TD

Tardive dyskinesia

TIM A

Texas Implementation of Medication

Algorithms

Self-assessment questions and answers are available at ht-tp://www. mhpharmacotherapy. com/pp.html.

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