Study Guide For Medication Treatment For Schizophrenia Spectrum and Other Psychosis Disorders

 

 

Study Guide For Medication Treatment For Schizophrenia Spectrum and Other Psychosis Disorders

 

 

Schizophrenia spectrum and other psychosis disorders negatively impact patients’ lives and usually present with various major symptoms such as abnormal or disorganized motor behaviors, disorganized speech or thinking, hallucinations, and delusions. The implication is that a mental health specialist should have adequate knowledge regarding these symptoms to correctly diagnose patients with these conditions and formulate appropriate treatment and management approaches (Van Weeghel et al.,2019). The process of learning about such aspects as a student requires various approaches, such as formulating study guides. As such, the purpose of this assignment is to formulate a study guide for medication treatment for schizophrenia spectrum and other psychosis disorders.

Description of the Psychopharmacological Medication

Schizophrenia spectrum and other psychosis disorders are treated using various psychopharmacological medication agents. One of the most common medication agents is risperidone. Risperidone is a typical antipsychotic medication taken by either injection or mouth (McNeil et al.,2023).

 Brand name Risperdal
Generic names Risperidone, Risperdal Consta
FDA indication Uses ·         Treatment of schizophrenia, especially for adults and children aged at least thirteen years

·         Treatment of bipolar I acute mixed or manic episodes in adults and children of at least ten years as a lone therapy (McNeil et al.,2023).

·         Treatment of bipolar I acute mixed or manic episodes in adults adjunctive with valproate or lithium.

·         Treatment of autism-associated irritability in children aged at least five years

Drug Classification Risperidone is a typical antipsychotic medication
Non-FDA uses ·         Treatment of PTSD, pedophilia, brain injury, depression, delirium, delusional disorder, and personality disorder

·         Treatment of agitation and aggression in patients with dementia (McNeil et al.,2023).

·         Hyperactivity in autism

 

Mechanism of Action

Risperidone, as earlier pointed is a typical antipsychotic medication. Since it is a second-generation antipsychotic, the medication acts by some D2 receptor blockage and the blockage of the serotonin receptors such as the 5HT2A. It has a loosed binding to the D2 receptors and hence can dissociate from the receptor fast enough (McNeil et al.,2023). One of the important aspects of the mechanism of action is that the blockade of the D2 receptors leads to improved positive symptoms and is key in improving psychiatric symptoms.

The Pharmacokinetics and Pharmacodynamics of The Medication

Study Guide For Medication Treatment For Schizophrenia Spectrum and Other Psychosis Disorders

Study Guide For Medication Treatment For Schizophrenia Spectrum and Other Psychosis Disorders

The medication is metabolized by the enzyme cytochrome P450 2D6 (CYP2D6) and is usually administered as long-acting injections and orally. The volume of distribution is 1 to 2 L/kg and binds to the alpha 1-acid glycoprotein and albumin (Dammerman et al.,2018). The plasma protein binding includes 77% for 9-hyrdoxyrisperidone and 90% for risperidone.

metabolism

The CYP2D6 is responsible for the hydroxylation of the risperidone to 9-hydroxy risperidone, a metabolite that has a similar activity as risperidone. The medication contains functional groups of piperidine and benzisoxazole. It acts on various receptors such as Dopamine receptors, serotonin receptors,  alpha-1 adrenergic receptors, alpha-2 adrenergic receptors, Histamine H1 receptors, and voltage-gated sodium channels (Dammerman et al.,2018).

Appropriate Dosing, Administration Route, and Considerations For Dosing Alterations

            For schizophrenia, the dosage initial dosage is 2 mg orally per day, with adjustments indicated under certain conditions. Titration doses may be in the form of 1 to 2 mg per day interval increments at 24 h intervals or as the patient can tolerate.  However, the dosage should not exceed 16 mg per day for adults. For older adults, the initial dose is 0.5 mg two times a day (Correll et al.,2021). For individuals from age thirteen to seventeen, the dosage should be 0.5 mg, once a day, either in the evening or morning. The long-acting injections are given as 25 mg IM every two weeks. In titration dose, the dose may be raised to 37.5 or 50 mg as determined by the doctor. The titration should happen no more frequently than every month. The maximum dose allowed is 50 mg IM every fortnight.

The medication has special considerations for use and dosing. For example, the medication should not be used by children under the age of thirteen years. The medication is originally meant for children under the age of thirteen. The medication can cause harm to the human fetus and, therefore, should be used under extreme care during pregnancy (Correll et al.,2021). Breastfeeding women should not breastfeed for at least twelve weeks after getting the long-acting version of the medication

The half-life of the medication

The half-life of a medication is defined as the time it takes for an amount of a medication’s active substance in a person’s body to reduce by half. Its importance is that it can act as a guide for how long a medication can take to reach a stable level in a person’s body when it is first taken. The half-life of risperidone is known to be three hours in extensive metabolizers and twenty hours in poor metabolizers (Schoretsanitis et al.,2019). In addition, the half-life of 9-hydroxy risperidone is thirty hours in poor metabolizers and twenty-one hours in extensive metabolizers

The Side Effects and Adverse reactions

Risperidone has been shown to help in the treatment of schizophrenia spectrum and other psychosis disorders. However, it has various side effects and adverse reaction

Side effects include:

  • Xeroderma, tachycardia, skin rash
  • Abdominal pain, weight gain
  • Rhinitis
  • Nausea
  • Extrapyramidal reaction, dystonia
  • Drowsiness, dizziness, constipation
  • Anxiety, akathisia, and agitation (Kloosterboer et al.,2021)

Potential adverse side effects include;

  • Sudden numbness or weakness in legs, arms, or face
  • Vision or speech problems
  • Chest pain
  • Back pain (McNeil et al.,2022)

Contraindications, Drug Interactions, and Overdose Considerations

The use of risperidone is contraindicated in various cases. For example, it should not be offered to patients under the age of thirteen. Individuals with diabetes, breast cancer, high prolactin levels, excessive fat in the blood, overweight, and those with low levels of white blood cells should not use this medication (McNeil et al.,2022). This medication has various drug interactions. The medication interacts with over five hundred medications. Common interactions include carbamazepine, levodopa, certain SSRIs such as Paxil and Prozac, medications that cause drowsiness, medications that increase prolactin levels, and blood pressure medications. In case of an overdose, a patient may present with various symptoms such as fever, diaphoresis, muscle spasms, hypotension, bradycardia, tachycardia, seizure, coma, and lethargy. Treatment of overdose may include vasopressor agents, anticonvulsants, diphenhydramine, and antiarrhythmics.

Diagnostics, Lab Monitoring, and Comorbidities Considerations

Effective use of the medication may require appropriate diagnostics and lab monitoring. Individuals using the medication are at heightened risk of various complications such as obesity, hypertension, hyperlipidemia, and diabetes, and monitoring may depend on a person’s health status, risk factors, preexisting conditions, and history. Monitoring should include TSJ, hepatic function tests, renal function tests, electrolytes, CBC, lipid pane, hemoglobin, BMI, blood pressure, and pulse (Taurines et al.,2022). Comorbidities should also be considered when administering the medication. For example, patients with schizophrenia and other conditions such as cancer and diabetes should not use the medication.

Legal and Ethical Considerations

The prescription of psychotropic medications comes along with legal and ethical considerations. Only authorized individuals should prescribe risperidone for use. In the prescription and use, the ethical principles of autonomy, beneficence, and non-maleficence should all prevail. The implication is that the right dosage should be prescribed for the patient, and the practitioner has to ensure that the patient is protected from harm at all times.

Patient Education

Effective use of risperidone requires that patients get adequate patient education. One of the major education points is that patients should follow the medication regimen as prescribed, and in the case that a dose is skipped, it should be taken as soon as the patient remembers. The patient should also be taught about the common side effects of the medication and how to cope with them (McNeil et al.,2022). Besides, they also need to be informed of the adverse effects, and that in case of such effects, then the medication should be stopped and a report made to the facility as soon as possible.

Conclusions

Schizophrenia spectrum and other psychotic disorders require appropriate management and treatment. Various factors should be considered before choosing a particular medication approach to help in the treatment of patients. In addition, patients should also be educated on potential side effects, adverse effects, and medication interactions.

 

 

 

 

 

 

References

Correll, C. U., Kim, E., Sliwa, J. K., Hamm, W., Gopal, S., Mathews, M., … & Saklad, S. R. (2021). Pharmacokinetic characteristics of long-acting injectable antipsychotics for schizophrenia: an overview. CNS drugs35(1), 39–59. https://doi.org/10.1007/s40263-020-00779-5

Dammerman, R., Kim, S., Adera, M., & Schwarz, A. (2018). Pharmacokinetics and safety of risperidone subcutaneous implants in stable patients with schizophrenia. Clinical Pharmacology In Drug Development7(3), 298-310. https://doi.org/10.1002/cpdd.428

Kloosterboer, S. M., de Winter, B. C., Reichart, C. G., Kouijzer, M. E., de Kroon, M. M., van Daalen, E., … & Koch, B. C. (2021). Risperidone plasma concentrations are associated with side effects and effectiveness in children and adolescents with autism spectrum disorder. British Journal of Clinical Pharmacology87(3), 1069-1081. https://doi.org/10.1111/bcp.14465

McNeil, S. E., Gibbons, J. R., & Cogburn, M. (2022). Risperidone. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459313/

Schoretsanitis, G., Villasante-Tezanos, A. G., & De Leon, J. (2019). Studies of half-lives of long-acting antipsychotics are needed. Pharmacopsychiatry52(01), 45-46. Doi: 10.1055/a-0755-7692

Taurines, R., Fekete, S., Preuss-Wiedenhoff, A., Warnke, A., Wewetzer, C., Plener, P., … & Egberts, K. M. (2022). Therapeutic drug monitoring in children and adolescents with schizophrenia and other psychotic disorders using risperidone. Journal of Neural Transmission129(5-6), 689-701. https://doi.org/10.1007/s00702-022-02485-6

Van Weeghel, J., van Zelst, C., Boertien, D., & Hasson-Ohayon, I. (2019). Conceptualizations, assessments, and implications of personal recovery in mental illness: A scoping review of systematic reviews and meta-analyses. Psychiatric Rehabilitation Journal42(2), 169. https://psycnet.apa.org/doi/10.1037/prj0000356