Microsoft word - medication.doc

Medication

Medication is often offered to people experiencing a first episode of
psychosis. It is often prescribed in conjunction with other treatments and
therapies (Link) and can be viewed as part of an overall care plan. For some
people, it can be very useful for reducing or stopping symptoms associated
with psychosis that may lead to distress and disruption. For many, this can
often come as a welcome relief. However, there are also many people who
feel worried by the idea of taking medication. They will often have many
questions yet feel unsure were to find the answers. This can be viewed as a
normal and understandable reaction and for this purpose; you may find the
following information helpful to inform both your choice and consent to
medication.
Ask Questions!
One way to discuss any concerns you may have about medication is to talk to
your doctor, Nurse or other health service provider. All should be happy to
explain medication choices with you and to look at any worries that you may
have. Medication is much more likely to help you in the long run if you are
able to trust the advice that you are given and feel that your concerns are
legitimately understood and acknowledged. For some people, writing down a
list of queries they would like to discuss often helps when seeing their Doctor,
Nurse or key worker. Being accompanied to an appointment by someone you
trust can also help with finding out the right information. You may wish to refer
to our own downloadable form (preparing for an appointment) to register any
concerns or queries you may have. Further information is also provided on
this link which you may find helpful.
Types of medication
There are generally two types of medication used for the treatment of
psychosis. They are the newer ‘atypical’ medications and the older
medications (also called 'conventional' antipsychotics). Newer medications
are viewed to be superior to older ones due to there reduced risk of side
effects and their potential for better overall outcomes. If offered medication by
your practitioner, you should by practice be offered an ‘atypical’ medication
(see below for types of). If not, you may wish to ask for a rationale as to why
not! Medication should also be prescribed at a low end dose range and
gradually built up to a therapeutic dose to effectively target symptoms and
minimise side effects. By rule of thumb, you may wish to think on the lines off
‘start low, increase slow’.
Medication can also be administered in different forms. For some people,
receiving an injection every two to four weeks can be less troublesome than
having to remember to take tablets on a daily basis. Some Medications can
also be prescribed in liquid form. Please refer to medications below for form
and dose range.

Atypical Medication Currently Licensed and Available on prescription in the UK
Amisulpride (Solian) – Tablet or solution. Dose range: 100-1200 mg
Aripriprazole (Abilify) – Tablet. Dose range 10 to 30 mg
Clozapine (Clozaril, Clopine) – Tablet. Clozipine is usually given if other
medications have not proved to be successful. Usually, a person will try at
least two antipsychotic medications before clozaril is considered. People
taking clozapine must have regular blood tests to check for early signs of a
very rare but serious blood disorder. These tests prevent serious problems
occurring. Dose range 12.5-600 mg
Olanzapine (Zyprexa) – Tablet, quick-dissolving wafer or intramuscular
injection. Dose range 5-20 mg
Quetiapine (Seroquel) – Tablet. Dose range 200-800 mg
Risperidone (Risperdal) – Tablet, quick-dissolving wafer, solution or long-
acting injection. Dose range 2-8 mg
Older (Typical) Medications Currently Licensed and Available on Prescription
in the UK

Chlorpromazine (Largactil) Dose range: 75-800 mg, also available as Intra muscular
Injection
Haloperidol (Haldol, Serenace) Dose range: 2-10 mg also available as Intra muscular
Injection
Trifluoperazine (Stelazine, Parstelin) Dose range: 2-30 mg
Zuclopenthixol (Clopixol) Dose range: 10-15 mg
Ok, so how does it work?
People experiencing symptoms of psychosis often report problems with seeing things
others cannot, hearing voices, imagining things and having terrifying thoughts. With
regards to medication, a popular theory about why this happens is the so-called
‘Dopamine hypotheses’.
Dopamine is a neurotransmitter within the brain which amongst other things is
involved and somewhat responsible for our perception. By perception, we mean the
brain processing information through the senses, which include touch, taste, sound,
smell and vision. Perception of theses types of sensory information also affects our
emotions.
If a person is given a drug that increases the activity of dopamine in the brain, it can
over stimulate the perceptual system. This can lead to a distortion of the senses and
induce symptoms often associated with psychosis. It is as if the senses as we
ordinarily experience veer of track and generate a surreal or dreamlike state. The
only difference from dreaming is that the dream like content is experienced when the
person is fully conscious and awake.
Amphetamines (speed) and other illicit substances are known to sometimes do this.
When this occurs, a person may be described as having a drug induced psychosis.
The basic principle is that too much dopamine is being produced and transmitted
from one nerve cell to the next creating ‘too much perception’. Put simply, medication

works by reducing dopamine activity, i.e. blocking the receptors at each nerve ending
so excess dopamine cannot pass through to the next nerve cell and in turn reducing
the symptoms of psychosis.
What are the side effects?
All medications have side-effects and the skill of prescribing is to achieve a
balance between desirable and unwanted effects. Individuals vary markedly in
their responses to different medications. Some of the common side-effects
are:
Drowsiness: is the most common side-effect. People who are drowsy shouldn't work
machinery or drive.
Dry mouth: for which we suggest people use sugarless gum to stimulate the
production of saliva.
Weight gain and/or constipation: People with these problems should have a
sensible, high-fibre diet and fluids combined with exercise. Body weight should be
monitored. A program should be put in place to combat expected gains on some
medications, such as olanzapine and clozapine.
Lowering of blood pressure: This can be experienced as dizziness or faintness.
Affected people should rise slowly from a sitting or lying position and sit on the side
of the bed before standing up. If symptoms persist, a medication review is necessary.
Menstrual disorders: or false positive pregnancy tests. If these side-effects persist
over a period of weeks, the client should return to the prescriber for a medication
review.
Agranulocytosis: Clozapine has a rare but fatal potential to depress the body's
white cells (which fight infection). Regular blood tests are needed to monitor the
white cell count.
Cardiac or heart problems: Many medications, but especially thioridazine and
clozapine, have caused potentially fatal heart problems, ranging from changes in
rhythm to inflammation. Heart health should therefore be monitored in people on
these medications, or in anyone with existing heart problems.
Neuroleptic Malignant Syndrome (NMS): A rare but potentially fatal syndrome that
can develop at any time. It is mostly seen in hospitals when acutely excited
individuals have been given large or rapidly escalating doses. The major features of
NMS are: fever, muscular rigidity, high and fluctuating blood pressure and pulse and
respiratory rates. Side-effects can be relieved by reducing or increasing medication,
or by adding different medications. Dystonias, Parkinsonian features and akathisia
can be treated with anticholinergics such as benztropine mesylate (Cogentin™),
benzhexol (Artane™), procyclidine hydrochloride (Kemadrin™) and orphenadrine
(Disipal™). Side-effects may be uncomfortable, but they often improve with time and
dose reduction. Stopping the medication "cold turkey" is not the answer. We strongly
recommend an immediate visit to the prescribing doctor.
Diabetes: Some recent research suggests that there may be a link between atypical
medications and an increased rate of diabetes. There is not an established causal
link. People taking atypical medications should discuss this issue with their treating
doctor and learn about the warning signs of diabetes so that if it is developing it can
be detected quickly and managed.
Another group is called extra-pyramidal side-effects. These affect certain muscles of the body and can lead to discomfort for the client. These are as follows: Dystonias: Eyes turning upwards, a distressing situation for the client who may need
immediate medical intervention; slurred speech; large muscle contractions leading to
odd posture or even arching of the back.
Parkinsonian features: tremor, muscular rigidity or absence of normal movement.
Akathisia: a feeling of generalised restlessness, often worse in the legs. People feel
unable to sit still, they must get up and move about. They feel worried and
uncomfortable.
Tardive dyskinesia: This involves an abnormal chewing of the lips and tongue,
sometimes movement of fingers and toes, and occasionally also trunk muscles. This
may be mild and barely noticeable. Of all the side-effects, it is the only one that is
irreversible if not treated early.
To stop medication without supervision may lead to deterioration in the person’s mental state. It is very important for people on long-term medication to have regular reviews. An underlying principle is that medication should be the minimum necessary to prevent relapse as well as minimising the risk of side-effects. This may only be achieved on a trial and error basis. What will happen to me when I start taking my antipsychotic?
Antipsychotic medication does not take effect straight away. For example, it may take
several days, or even weeks, for some of the symptoms to reduce. To begin with,
most people find that this medication will help them feel more relaxed and calm.
Later, after one or two weeks, other symptoms should begin to improve.
How long will I have to take my medication for?
There is no set rule for how long someone should remain on medication. Like many
other mental health problems, a variety of factors needs to be taken into account
when deciding when someone should come off medication. Current thinking
suggests that the risk of relapse is highest within the first three years from onset of a
first episode psychosis. It is during this period that medication, in addition to other
interventions can prove helpful for not only reducing psychotic symptoms but also
protecting a person from further encountering symptoms. Guidance would
recommend the continuation of medication for up to a period of two years following a
psychotic episode. Any decision to stop taking medication should be discussed with
your Doctor or care worker with a shared plan put in place to support any decision
made. Withdrawal from antipsychotic medication ought to be gradual with regular
monitoring for any signs of symptom re-emergence.

Source: http://www.strangedays.org.uk/downloads/1%20Medication.pdf