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The Role of Atypical Antipsychotics in Sexuality: Road to Recovery in Schizophrenia

Adam RL, Sidi H, Midin M, Zakaria H, Das S, Mat KC

Curr Drug Targets, 2018;19(12):1402-1411.
PMID: 28464773 DOI: 10.2174/1389450118666170502130126

Sexuality is an important dimension in human beings as a form of expression of individuality. For many decades, sexual functioning has been a neglected area among patients suffering from schizophrenia. It was a presumption that patients with schizophrenia could be asexual and this could be secondary to overwhelming situations of delusion, hallucination, hostility and negative symptoms among others. The deficient in sexual functioning are due to innate factors, i.e. negative symptoms (apathy, avolition and amotivation) and also as a result of prefrontal dysfunction, i.e. inability to plan and execute meaningful relationship. Adverse effects of the psychopharmacological agents, especially the typical antipsychotics, e.g. dystonia, excessive sedation and hyperprolactinemia may interfere with patients' sexual activity. In this review, we highlight the neurobiology of schizophrenia in the context of understanding sexual functioning and to integrate the knowledge of dopamine-serotonin neurotransmitter's interaction and the receptors' target. Interventional approaches consist of psychopharmacological and psychosocial interventions. In the perspective of sexuality, we recommend atypical antipsychotic should be placed as the first line treatment for both drug naïve patients and also to patients who are already receiving psychopharmacological agents in consideration for a drug-switch from typical to atypical antipsychotics. Aripiprazole, clozapine, olanzapine and quetiapine exert benefits in terms of sexual functioning recovery due to their atypical mechanism of action. However, the potential adverse effect like metabolic syndrome should be adequately managed to prevent negative consequences. Psychosocial interventions, i.e. psychoeducation, destigmatization, supportive psychotherapy and psychiatric rehabilitation also play a crucial role in the management. In conclusion, restoration of sexual function is an achievable recovery target in patients with schizophrenia through these biopsycho- social interventions.

Matched MeSH terms: Antipsychotic Agents/pharmacology*; Antipsychotic Agents/therapeutic use
Failure of clonidine in tardive dystonia: implications for nosology

Adityanjee, Singh S, Subramaniam M

Biol Psychiatry, 1989 Jun;26(2):199-202.
PMID: 2567611
Matched MeSH terms: Antipsychotic Agents/administration & dosage; Antipsychotic Agents/adverse effects*
Fulltext Clozapine re-challenge with lithium supplementation following clozapine-induced neutropenia

Ahmad Nabil Md Rosli, Subbiah, Rakesh, Maniam, T.

ASEAN Journal of Psychiatry, 2014;15(1):90-92.
MyJurnal

Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatment- resistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 90-92.

Matched MeSH terms: Antipsychotic Agents
Fulltext Memantine augmentation in the treatment of frontal lobe syndrome in patients with end-stage renal disease: a case report

Aida Abdul Razak, Maniam, T., Hatta Sidi, Shalisah Sharip, Suriati Mohamed Saini

ASEAN Journal of Psychiatry, 2014;15(1):93-96.
MyJurnal

Objective: This case report highlights the challenges in managing Frontal Lobe Syndrome (FLS) in a patient with end-stage renal disease. Methods: This is a case description of a 58 year-old gentleman who presented with behavioural changes: irritability, mood lability, aggression, psychosis, and overfamiliarity. His presenting symptoms were in keeping with (FLS) with positive findings on Computed Tomography (CT) scan of the brain and also neuropsychological assessments. Difficulties arose in attempts to control his aggression without further compromising his renal function. Results: The usage of the commonly used antipsychotics in controlling aggression was restricted in view of the patient’s renal impairment. Augmentation with low dose memantine proved to be beneficial in this case, without causing further deterioration in renal function. Conclusion: The use of memantine to augment the effect of risperidone was observed to be safe and successful in managing the behavioural changes associated with FLS in adults with end-stage renal disease. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 93-96.

Matched MeSH terms: Antipsychotic Agents
Capgras syndrome in a very late onset, treatment resistant schizophrenia

Ain MK, Rosdinom R, Raynuha M

Int Psychogeriatr, 2015 Sep;27(9):1573-5.
PMID: 25794136 DOI: 10.1017/S1041610215000332

We report a Malay man, with underlying chronic medical illnesses, presenting with positive symptoms of schizophrenia, including Capgras syndrome (CS) at the age of 73. Physical examination and blood investigations were normal and brain CT scan showed age-related cerebral atrophy. Neuropsychological assessment showed probable right hemisphere lesions but relatively intact memory and intellectual functions. Several neuroleptics including depot injections were tried but ineffective. Positive symptoms including CS eventually improved with clozapine before his death from myocardial infarction. This case report highlights the uncommon occurrence of CS in treatment resistant schizophrenia (TRS) of very late onset and its treatment challenges.

Matched MeSH terms: Antipsychotic Agents/therapeutic use*
Discovery of natural product inhibitors of phosphodiesterase 10A as novel therapeutic drug for schizophrenia using a multistep virtual screening

Al-Nema M, Gaurav A, Akowuah G

Comput Biol Chem, 2018 Dec;77:52-63.
PMID: 30240986 DOI: 10.1016/j.compbiolchem.2018.09.001

The major complaint that most of the schizophrenic patients' face is the cognitive impairment which affects the patient's quality of life. The current antipsychotic drugs treat only the positive symptoms without alleviating the negative or cognitive symptoms of the disease. In addition, the existing therapies are known to produce extrapyramidal side effects that affect the patient adherence to the treatment. PDE10A inhibitor is the new therapeutic approach which has been proven to be effective in alleviating the negative and cognitive symptoms of the disease. A number of PDE10A inhibitors have been developed, but no inhibitor has made it beyond the clinical trials so far. Thus, the present study has been conducted to identify a PDE10A inhibitor from natural sources to be used as a lead compound for the designing of novel selective PDE10A inhibitors. Ligand and structure-based pharmacophore models for PDE10A inhibitors were generated and employed for virtual screening of universal natural products database. From the virtual screening results, 37 compounds were docked into the active site of the PDE10A. Out of 37 compounds, three inhibitors showed the highest affinity for PDE10A where UNPD216549 showed the lowest binding energy and has been chosen as starting point for designing of novel PDE10A inhibitors. The structure-activity-relationship studies assisted in designing of selective PDE10A inhibitors. The optimization of the substituents on the phenyl ring resulted in 26 derivatives with lower binding energy with PDE10A as compared to the lead compound. Among these, MA 8 and MA 98 exhibited the highest affinity for PDE10A with binding energy (-10.90 Kcal/mol).

Matched MeSH terms: Antipsychotic Agents/chemical synthesis; Antipsychotic Agents/pharmacology*; Antipsychotic Agents/chemistry
Phosphodiesterase as a Target for Cognition Enhancement in Schizophrenia

Al-Nema MY, Gaurav A

Curr Top Med Chem, 2020;20(26):2404-2421.
PMID: 32533817 DOI: 10.2174/1568026620666200613202641

Schizophrenia is a severe mental disorder that affects more than 1% of the population worldwide. Dopamine system dysfunction and alterations in glutamatergic neurotransmission are strongly implicated in the aetiology of schizophrenia. To date, antipsychotic drugs are the only available treatment for the symptoms of schizophrenia. These medications, which act as D2-receptor antagonist, adequately address the positive symptoms of the disease, but they fail to improve the negative symptoms and cognitive impairment. In schizophrenia, cognitive impairment is a core feature of the disorder. Therefore, the treatment of cognitive impairment and the other symptoms related to schizophrenia remains a significant unmet medical need. Currently, phosphodiesterases (PDEs) are considered the best drug target for the treatment of schizophrenia since many PDE subfamilies are abundant in the brain regions that are relevant to cognition. Thus, this review aims to illustrate the mechanism of PDEs in treating the symptoms of schizophrenia and summarises the encouraging results of PDE inhibitors as anti-schizophrenic drugs in preclinical and clinical studies.

Matched MeSH terms: Antipsychotic Agents
Fulltext Polypharmacy, An Option Prior To Clozapine?: A Case Report

Amer Siddiq, A.N.

Medicine & Health, 2008;3(2):318-321.
MyJurnal

This is a report of a patient on multiple antipsychotic medications for the treatment of schizophrenia. Often, polypharmacy is not encouraged, however, with the advent of newer atypical antipsychotic agents, this practice may need review. This case will be used to highlight the rare instances when polypharmacy may be useful prior to the commencement of clozapine for the treatment of schizophrenia.

Matched MeSH terms: Antipsychotic Agents
Genderwise clinical response of antipsychotics among schizophrenic patients: a prospective observational study from Lahore, Pakistan

Asif U, Saleem Z, Yousaf M, Saeed H, Hashmi FK, Islam M, et al.

Int J Psychiatry Clin Pract, 2018 Sep;22(3):177-183.
PMID: 29082784 DOI: 10.1080/13651501.2017.1395055

OBJECTIVE: The study was aimed to evaluate the gender specific response to adherence and occurrence of side effects among schizophrenic patients in Lahore, Pakistan.
METHODS: A prospective study was performed for a period of 1 year among 180 newly diagnosed schizophrenics, aged 20-60 years to observe the symptoms, medication adherence and side effects. Morisky-Green-Levine Scale was used to evaluate medication adherence, LUNSER for side effects and PANSS to measure positive and negative symptoms. Data were analyzed using SPSS.
RESULTS: Positive symptoms (Male: Baseline 36.14 vs. endpoint 23.58, Female: 35.29 vs. 23.74) and negative symptoms (Males 27.9 vs. 20.05, Females 28.41 vs. 20.2) of schizophrenia were equally reduced after a follow up of 1 year in both the genders. Male population suffered more accumulative side effects (11.4 in males vs. 6.40 in females), extrapyramidal symptoms such as tardive dyskinesia and tremors (1.21 in males vs. 0.57 in females) and other side effects as compared to women (p ≤ .005). Males were found poorly adherent to antipsychotic treatment than females (93.3% in males vs. 6.7% in females (p ≤ .005).
CONCLUSIONS: Prescribing practices should not overlook sex specific factors like hormonal changes, altered brain morphology and socioeconomic factors that may be responsible for the difference in the response to the course of schizophrenia.

Matched MeSH terms: Antipsychotic Agents/adverse effects; Antipsychotic Agents/pharmacology*
Hypersexuality As a Neuropsychiatric Disorder: The Neurobiology and Treatment Options

Asiff M, Sidi H, Masiran R, Kumar J, Das S, Hatta NH, et al.

Curr Drug Targets, 2018;19(12):1391-1401.
PMID: 28325146 DOI: 10.2174/1389450118666170321144931

Hypersexuality refers to abnormally increased or extreme involvement in any sexual activity. It is clinically challenging, presents trans-diagnostically and there is extensive medical literature addressing the nosology, pathogenesis and neuropsychiatric aspects in this clinical syndrome. Classification includes deviant behaviours, diagnosable entities related to impulsivity, and obsessional phenomena. Some clinicians view an increase in sexual desire as 'normal' i.e. psychodynamic theorists consider it as egodefensive at times alleviating unconscious anxiety rooted in intrapsychic conflicts. We highlight hypersexuality as multi-dimensional involving an increase in sexual activity that is associated with distress and functional impairment. The aetiology of hypersexuality is multi-factorial with differential diagnoses that include major psychiatric disorders (e.g. bipolar disorder), adverse effects of treatments (e.g. levodopatreatment), substance-induced disorders (e.g. amphetamine substance use), neuropathological disorders (e.g. frontal lobe syndrome), among others. Numerous neurotransmitters are implicated in its pathogenesis, with dopamine and noradrenaline playing a crucial role in the neural reward pathways and emotionally- regulated limbic system neural circuits. The management of hypersexuality is determined by the principle of de causa effectu evanescent, if the causes are treated, the effect may disappear. We aim to review the role of pharmacological agents causing hypersexuality and centrally acting agents treating the associated underlying medical conditions. Bio-psycho-social determinants are pivotal in embracing the understanding and guiding management of this complex and multi-determined clinical syndrome.

Matched MeSH terms: Antipsychotic Agents/therapeutic use
Fulltext Comparison of risperidone and other neuroleptics in the management of chronic schizophrenia using cognitive therapy

Azhar MZ

Med J Malaysia, 2000 Mar;55(1):7-13.
PMID: 11072484

A number of psychological approaches to alleviating psychotic symptoms have been reported in the literature. The latest technique among them is cognitive therapy (CT). This paper describes an open trial that makes use of cognitive psychotherapy to treat chronic drug resistant delusions (more than 2 years duration) in 20 patients with schizophrenia. The positive response of all patients with the absence of symptom replacement and maintenance of response at 3 months follow-up, seem to imply that this technique is useful and more effort needs to be invested into this new area of psychotherapy for psychosis. This paper also shows that those patients on risperidone maintenance respond better to CT than those on other neuroleptics.

Matched MeSH terms: Antipsychotic Agents/therapeutic use*
Antiepileptic-induced Psychosis as a Possible Predictor of Post-temporal Lobectomy Alternative Psychosis

Benedict F, Lim KS, Jambunathan ST, Hashim AH

East Asian Arch Psychiatry, 2016 Sep;26(3):109-11.
PMID: 27703099

We present a patient with topiramate-induced psychosis who developed alternative psychosis following temporal lobectomy. The number of surgical candidates for temporal lobectomy is increasing as is the frequency of psychiatric co-morbidities. Preoperative planning should take account of these psychiatric co-morbidities. In particular, precautions should be taken when antiepileptic drug-induced psychosis occurs, as this could predict the occurrence of alternative psychosis following lobectomy.

Matched MeSH terms: Antipsychotic Agents/therapeutic use
Characteristics of patients with organic brain syndromes : A cross-sectional 2-year follow-up study in Kuala Lumpur, Malaysia

Chandrasekaran PK, Jambunathan ST, Zainal NZ

Ann Gen Psychiatry, 2005 Apr 15;4(1):9.
PMID: 15876360

BACKGROUND: Organic Brain Syndromes (OBS) are often missed in clinical practice. Determining their varied presentations may help in earlier detection, better management, and, assessing prognosis and outcome. We described the in-patient referrals of patients suffering from the psychiatric effects of organic states and compared the symptomatology and mortality between those with the Acute and Chronic varieties. METHODS: 59 patients referred to our Consultation-Liaison (C-L) Psychiatry services and given a clinical diagnosis of OBS were selected over a 6-month period. Psychiatric and cognitive abnormalities and treatment regimes were recorded and fatality rates determined. Information regarding their condition 24 months after their index hospitalization was recorded. All data were entered into a proforma and analyzed after exclusion. RESULTS: The mean duration of detecting the symptoms by the physician was 3.52 days. The presence of a premorbid psychiatric illness had no influence on the clinical presentation but did on the mortality of patients with OBS (p = 0.029).Patients with the Acute syndrome had significantly more symptom resolution as compared to those with the Chronic syndrome (p = 0.001) but mortalityrates did not differ. Elderly patients and those with symptom resolution upon discharge did not show statistically significant higher mortality rates. The most popular combination of treatment was that of a low-dose neuroleptic and a benzodiazepine (34.7%). The need for maintenance treatment was not significantly different in any group, even in those with a past history of a functional disorder. CONCLUSION: Other than the Acute group having a significantly better outcome in terms of symptom resolution, our findings suggest that there was no significant difference in the clinical presentation between those with Acute or Chronic OBS. Mortality-wise, there was also no difference between the Acute and Chronic syndromes, nor was there any difference between the elderly and the younger group. There was also no significant difference in the need for continued treatment in both groups.

Matched MeSH terms: Antipsychotic Agents
Fulltext Agranulocytosis monitoring with Clozapine patients: to follow guidelines or to attempt therapeutic controversies?

Chandrasekaran PK

Singapore Med J, 2008 Feb;49(2):96-9.
PMID: 18301833

Clozapine is an atypical antipsychotic with superior efficacy in the treatment of refractory schizophrenia. But it can cause agranulocytosis, which occurs in one to two percent of patients. This paper was prepared to discuss the condoned and controversial issues of therapy with this drug, but only within a haematological context. The feasibility of attempting therapeutically controversial blood monitoring regimes, as opposed to following standardised Western guidelines, given the differences in terms of accessibility, convenience and financial considerations between the public and private sector medical care will also be discussed. The proposal of adopting a structured pro forma, with a risk-benefit assessment, in the event of unavoidable veering from the guidelines may allay medicolegal implications, especially in countries where blood monitoring is not mandatory. It is hoped that this article will stimulate further research in our region, bearing in mind the increasing awareness and focus on genetic polymorphism, and the possibility of drawing up our own monitoring guidelines in the near future.

Matched MeSH terms: Antipsychotic Agents/adverse effects*
Fulltext Explicit potentially inappropriate medications criteria for older population in Asian countries: A systematic review

Chang CT, Teoh SL, Rajan P, Lee SWH

Res Social Adm Pharm, 2023 Aug;19(8):1146-1156.
PMID: 37277240 DOI: 10.1016/j.sapharm.2023.05.017

BACKGROUND: Explicit potentially inappropriate medications (PIM) criteria are commonly used to identify and deprescribe potentially inappropriate prescriptions among older patients. Most of these criteria were developed specifically for the Western population, which might not be applicable in an Asian setting. The current study summarizes the methods and drug lists to identify PIM in older Asian people.
METHODS: A systematic review of published and unpublished studies were carried out. Included studies described the development of explicit criteria for PIM use in older adults and provided a list of medications that should be considered inappropriate. PubMed, Medline, EMBASE, Cochrane CENTRAL, CINAHL, PsycINFO, and Scopus searches were conducted. The PIMs were analyzed according to the general conditions, disease-specific conditions, and drug-drug interaction classes. The qualities of the included studies were assessed using a nine-point evaluation tool. The kappa agreement index was used to evaluate the level of agreement between the identified explicit PIM tools.
RESULTS: The search yielded 1206 articles, and 15 studies were included in our analysis. Thirteen criteria were identified in East Asia and two in South Asia. Twelve out of the 15 criteria were developed using the Delphi method. We identified 283 PIMs independent of medical conditions and 465 disease-specific PIMs. Antipsychotics were included in most of the criteria (14/15), followed by tricyclic antidepressants (TCAs) (13/15), antihistamines (13/15), sulfonylureas (12/15), benzodiazepines (11/15), and nonsteroidal anti-inflammatory drug (NSAIDs) (11/15). Only one study fulfilled all the quality components. There was a low kappa agreement (k = 0.230) between the included studies.
CONCLUSION: This review included 15 explicit PIM criteria, which most listed antipsychotics, antidepressants, and antihistamines as potentially inappropriate. Healthcare professionals should exercise more caution when dealing with these medications among older patients. These results may help healthcare professionals in Asian nations to create regional standards for the discontinuation of potentially harmful drugs for elderly patients.

Matched MeSH terms: Antipsychotic Agents*
Outcome study of first-episode schizophrenia in a developing country: quality of life and antipsychotics

Chee KY

Soc Psychiatry Psychiatr Epidemiol, 2009 Feb;44(2):143-50.
PMID: 18642120 DOI: 10.1007/s00127-008-0415-0

AIM: Quality of life has recently been emphasized in the management of schizophrenia, yet data from developing country is lacking. We explored the differences in subjective quality of life between conventional antipsychotics (CAs) and atypical antipsychotics (AAs).
METHODS: This is a naturalistic study conducted in Kuala Lumpur, Malaysia. Patients with first-episode schizophrenia and related psychosis were recruited from Kuala Lumpur Hospital. WHOQOL-BREF, side effects of medications and other variables were assessed after 1 year of treatment in routine clinical situation.
RESULTS: The study comprised 120 adults. There were no significant statistical differences between groups concerning subjective quality of life, extrapyramidal side effects and employment. Significant less benzhexol usage was reported among AAs (P<0.001) compared to CAs and sulpiride.
CONCLUSION: Patients treated with CAs, sulpiride or AAs experienced similar quality of life, clinical and health outcomes after 1 year commencing treatment. Overall, the results are in line with other major pragmatic clinical trials. This study also found sulpiride cost-effective.

Matched MeSH terms: Antipsychotic Agents/therapeutic use*
Fulltext A double blind comparison of zuclopenthixol acetate with haloperidol in the management of acutely disturbed schizophrenics

Chin CN, Hamid AR, Philip G, Ramlee T, Mahmud M, Zulkifli G, et al.

Med J Malaysia, 1998 Dec;53(4):365-71.
PMID: 10971979

The aim of this study was to evaluate the efficacy and side effects of zuclopenthixol acetate compared with haloperidol in the management of the acutely disturbed schizophrenic patient. Suitable subjects diagnosed as having schizophreniform disorder or acute exacerbation of schizophrenia admitted to the psychiatric wards Hospital Kuala Lumpur were randomised to receive either zuclopenthixol acetate or haloperidol. They were rated blind for three consecutive days using the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and UKU Side Effects Scale. Apart from repeat injections of the same medication, no other anti-psychotic was given for the duration of the study. 50 subjects entered the study of which 44 completed. 23 were given zuclopenthixol acetate and 21 haloperidol. Both groups significantly reduced BPRS and CGI scores on all 3 days compared to the initial rating (p < 0.001). There was however no difference between the zuclopenthixol acetate and haloperidol group scores on all days (p > 0.05). More subjects on haloperidol than zuclopenthixol required more than 1 injection during the study. Both groups had minimal side effects. Zuclopenthixol acetate was effective in the management of the acutely disturbed schizophrenic.

Matched MeSH terms: Antipsychotic Agents/adverse effects; Antipsychotic Agents/therapeutic use*
Tardive dyskinesia among Chinese and Malay patients with schizophrenia

Chong SA, Mahendran R, Machin D, Chua HC, Parker G, Kane J

J Clin Psychopharmacol, 2002 Feb;22(1):26-30.
PMID: 11799339

The prevalence of tardive dyskinesia (TD) was studied with the Abnormal Involuntary Movements Scale in Chinese and Malay patients with schizophrenia who were hospitalized in a Singapore state psychiatric institute. We also studied the relationship of neuroleptic-induced extrapyramidal side effects to TD. By using established criteria, the rates of TD were 40.6% for Chinese and 29.0% for Malays, higher than previously reported for Chinese subjects. Older age and lower current neuroleptic dose were significantly associated with TD. Multivariate analysis, after controlling for other salient risk variables, did not show a significant difference in TD prevalence rates between the two races. We conclude that suggested differences in interethnic rates of TD among Chinese, Malays, and Westerners are unlikely to exist and that any variation in prevalence is more likely to be determined by differences in duration of exposure and dose levels of neuroleptic drugs.

Matched MeSH terms: Antipsychotic Agents/adverse effects*; Antipsychotic Agents/therapeutic use
Real-world evidence of improved healthcare utilization in patients with schizophrenia or schizoaffective disorder after early treatment of paliperidone palmitate once-monthly treatment in Hong Kong

Choon JWY, Wu DBC, Chong HY, Lo WTL, Chong CSY, Chung WS, et al.

J Med Econ, 2019 Mar;22(3):273-279.
PMID: 30561238 DOI: 10.1080/13696998.2018.1560749

BACKGROUND: Very few data are available to demonstrate the economic benefit of early paliperidone palmitate once-monthly long-acting injectable (PP1M) treatment in patients with schizophrenia or schizoaffective disorder.
METHODS AND MATERIALS: This study has retrospectively compared the healthcare utilization and associated costs of pre- and post-PPIM treatment in 413 patients with schizophrenia or schizoaffective disorder recruited from three major public hospitals providing psychiatric services in Hong Kong. Patients were categorized into early treatment (≤3 years since diagnosis) and chronic (>3 years) groups, and also whether they were receiving polypharmacy (POP).
RESULTS: It was found that patients who were started on early therapy with no POP had the most favourable outcomes. Overall results of the entire cohort, including both early and late treatments, indicate that there was a slight increase in annual in-patient days (IP) per patient and outpatient visit (OP) by 3.18 and 1.87, respectively, and a decrease in emergency room visit (ER) of 0.9 (p

Matched MeSH terms: Antipsychotic Agents/administration & dosage; Antipsychotic Agents/economics; Antipsychotic Agents/therapeutic use*
Fulltext Schizophrenia and anaesthesia

Constance LSL, Lansing MG, Khor FK, Muniandy RK

BMJ Case Rep, 2017 Nov 23;2017.
PMID: 29170175 DOI: 10.1136/bcr-2017-221659

Administering anaesthesia for elderly patients with chronic schizophrenia has always been a great challenge to anaesthetists. These patients will usually be on multiple antipsychotic drugs for many years and may lead to delayed awakening, cardiovascular instability, arrhythmias and sudden cardiac death during general anaesthesia. This case report is about the perioperative anaesthetic management of an elderly schizophrenic patient undergoing removal of femur implant. This article will explore important drug interactions and available options for a successful anaesthesia.

Matched MeSH terms: Antipsychotic Agents/adverse effects*

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