Medication Treatment Schizophrenia Spectrum
Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorder
World Health Organization (2009) explains that mental disorders account for 12% of the global disease burden. Out of the number of those with mental disorders, only a few get treated. The issue of mental illness is better addressed in developed countries than in developing countries. One of the most severe and frightening mental illnesses is schizophrenia. Media well familiarises the disorder, the public, and medical healthcare professionals due to its severe symptoms of hallucinations, delusions, disturbance in thoughts, and restlessness (Hany et al., 2022). A mention of the disease arouses anxiety in many social contexts. According to a recent review by the World Health Organization on ways of treating mental disorders, the conclusion was that better results are realized when both psychosocial and pharmacological approaches are used to treat mental disorders. Both pharmacological and non-pharmacological treatment of schizophrenia and other psychosis disorder are well developed, and the only limitation is access to these services by the patients and families.
Pharmacological treatment of schizophrenia and other mental disorders requires understanding pathophysiological events in the patient’s brain, the expressing symptoms, the attributing factors, the pharmacodynamics of the psychotropic medications, and other related reactions due to the effects of the medications. There are several developed medications for the treatment of psychosis. Different types of medications can have similar pharmacological effects at different degrees. Currently, the primary drugs used in managing mental disorders are chlorpromazine, fluphenazine, and haloperidol. For managing specific psychotic disorders, drugs such as amitriptyline, Flupenthixol, and fluoxetine are used World Health Organization. (2009).
According to the prescriber, the FDA is responsible for making medications safe and quality and ensuring exemplary medication performance. The administration ensures that the generic medications are created according to the brand name. Generic names are copies of the brand names. Patients need to understand the various brand names and generic names of psychotropic drugs they buy. Generic names come after the brand name of a drug that has been on the market for a long time.
Jataveda et al. (2014) explain that one of the currently used medications for schizophrenia is Flupenthixol, also known as depixol, fluanxol, or flupentixol which is also the generic name. The drug is mainly used in Canada and other countries but not in the USA. Flupenthixol decanoate is mainly used in the long-term treatment of schizophrenia due to its long-acting depot injections (Jataveda et al., 2014). It is also used to manage depression symptoms in patients who express signs of anxiety. Flupenthixol is a first-generation antipsychotic medication and a potent antagonist of D1 and D2 dopamine receptors. The drug exists in two geometric isomers and is marketed under depixol and Fluaxol. Flupenthixol exists in two geometric isomers. Flupenthixol’s structure is shown below, both 2D and 3D, respectively.
Figure 1. 2D
Figure 2. 3D
| Group | Geometric Isomers | Active ingredient | Brand Names | |
| Thioxanthene | Trans E | Cis Z | Flupentixol decanoate | Depixol
Fluanxol |
In the U.S., the Food and Drug Administration does not recognize the marketing of Flupenthixol in patients with schizophrenia or any other psychotic condition. However, the indications of use are in patients with chronic schizophrenia who do not express signs such as excitement, agitation, or hyperactivity. It can also be used in patients with depression who do not express signs of anxiety. When used together with melitracen, it can be used to control the symptom of asthenia, anxiety, and depression in adults.
Medication Mechanism of Action
Flupentixol is administered intramuscularly at an interval of two and four weeks. Has a half-life of three to 8 days. The hydrolysis of decapitating ester in the system occurs rapidly from cis Z flupenthixol. There are no active metabolites in Flupenthixol, and a steady state is attained in three months.
Understanding the half-life of drugs allows the determination of the exact time when an initial drug would have cleared from the system before the introduction of another drug or the minimum amount of drug remaining at a given time that cannot cause a significant effect when it interacts with a new drug. Another consideration is toxicity. Drugs with longer half-lives can cause toxicity or other adverse effects (Currie, 2018). It is a special consideration when administering and changing medications.
Figure 3 demonstrates the concept of a half-life.
In the above diagram, the time taken for 8 mg to reduce upto 4 mg is called the half-life, similarly from 4mg to 2 mg. Some antipsychotic drugs have adverse effects when administered. A physician’s ethical responsibility is to understand some of the adverse effects of psychotropic drugs.
The first-generation antipsychotic drugs’ mode of action inhibits dopaminergic neurotransmitters in the brain. They also express histaminergic, noradrenergic, and cholinergic blocking action (Chokhawala & Stevens, 2022). Maximum effectiveness is achieved when the drugs block 72% of the D2 dopamine receptors in the brain. The second-generation antipsychotic mode of action is achieved by blocking D2 and serotonin receptors in the brain. The most targeted serotonin receptor is the 5-HT2A subtype. Most antipsychotic medications are highly lipophilic and easily cross lipoidal membranes (Javaid, 1994). Oral administration of antipsychotic medications is marked by absorption and pre-systemic elimination. They are then bounded to plasma proteins and tissues and distributed extensively. Hepatic metabolism contributes the most significant proportion of antipsychotic elimination (Javaid, 1994). Biotransformation is carried out, and active metabolites are produced.
Dosing
Caution needs to be taken when administering antipsychotic drugs. According to the FDA, the routes of administration of antipsychotic drugs are oral, intramuscular, and intravascular. According to the principle and guidelines of the FDA, one antipsychotic medication used to be used at a time. The ethical aspect of drug administration also dictates consent to other side effects associated with certain antipsychotic medications (Frank et al., 2005). High doses of antipsychotic medications predispose the patient to other risks with no additional benefit. There should be considerations of minimum effective doses. Other considerations include the application of long-acting antipsychotics only when the disorder is severe. Drug switching is recommended, but the initial antipsychotic drug must gradually be cleared from the system while increasing the new one. World Health Organization, (2009).
Overdose flupentixol medications can only express side effects when other substances, such as alcohol and benzodiazepines, are used or ingested together with antipsychotic drugs. World Health Organization, (2009). Signs of overdose include tachycardia, rhythmic hypothermia, and seizures. Caution must be taken when administering the drug to elderly patients with dementia or other cognitive impairment; the administration of flupentixol medications should be half to one-third of the adult dose. The same applies to elderly patients susceptible to parkinsonian and anticholinergic side effects. World Health Organization, (2009). In children and adolescents, toxicity risks should be considered in cases of overdose.
Ethical Consideration during Pharmacological Treatment.
Antipsychotic drugs keep on changing with time as advanced research continues. It is an honest recommendation for a medical professional to continue to learn about new drugs based on their psychopharmacological effects, adverse effects, and contraindications. The practice ensures consent of all attributing factors when administering drugs to patients. One of the principles of ethical practice is to protect patients from harm (Dunn, 2016). The medical profession should ensure such ethical aspects apply in their professional practice by administering the proper medications for a carefully considered mental disorder diagnosis. Patients also have the right to express autonomy; therefore, their opinions should be considered when administering medications unless they pose a danger to themselves and others.
Pertinent Patient Education
Pharmacological treatment needs the support of other medical healthcare practices to promote recovery. Physicians must therefore spend more time with a psychotic patient and ensure motivation, enthusiasm, and responsiveness while interacting with the patients. Suicidal cases due to mental disorders have been on the rise in the recent past (Patrick et al., 2017). Instances of drug and substance abuse also contribute to the annual total deaths by a significant percentage. Furthermore, over 50% of the annual mortality toll involved premature individuals in the U.S. in the early 1990s (Patrick et al., 2017). Today the number has escalated. Physicians are urged to maintain a close connection with psychotic patients and recodify such behaviors through education programs.
References
Chokhawala, K., & Stevens, L. (2021). Antipsychotic medications. InStatPearls[Internet].StatPearls Publishing.https://www.ncbi.nlm.nih.gov/pubmed/30137788
Currie,G.M.(2018).Pharmacology,part2:introduction to pharmacokinetics. Journal of Nuclear Medicine Technology, 46(3), 221-230. https://tech.snmjournals.org/content/46/3/221.short
Dunn, C.(2016). Ethical issues in mental illness. Routledge. https://www.taylorfrancis.com/books/mono/10.4324/9781315256115/ethical-issues-mental-illness-caroline-dunn
Frank, R. G., Conti, R. M., & Goldman, H. H. (2005). Mental health policy and psychotropic drugs. The Milbank Quarterly, 83(2), 271–298.https://doi.org/10.1111%2Fj.1468-0009.2005.00347.x
Hany M, Rehman B, Azhar Y, Chapman J. Schizophrenia. (2022). In: StatPearls [Internet]. Treasure Island (F.L.): StatPearls Publishing; 2022Jan–.PMID: 30969686.https://www.ncbi.nlm.nih.gov/pubmed/30969686
Javaid, J. I. (1994). Clinical pharmacokinetics of antipsychotics. Journal of Clinical Pharmacology, 34(4), 286–295.https://doi.org/10.1002/j.1552-4604.1994.tb01995.x
Mahapatra, J., Quraishi, S. N., David, A., Sampson, S., & Adams, C. E. (2014). Flupenthixol decanoate (depot) for schizophrenia or other similar psychotic disorders. Cochrane Database of Systematic Reviews, (6).https://doi.org/10.1002%2F14651858.CD001470.pub2
Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017, January). Improving health outcomes through patient education and partnerships with patients. Baylor University Medical Center Proceedings (Vol. 30, No. 1, pp. 112-113). Taylor & Francis.https://doi.org/10.1080%2F08998280.2017.11929552
World Health Organization. (2009). Pharmacological treatment of mental disorders in primary health care. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/44095/9789241547697_eng.pdf