pressants, monoamine oxidase inhibitors) that exert antago- nist effects at muscarinic receptors. They include dry mouth, blurred vision, urinary hesitancy or retention, and constipa- tion. Similar antagonistic effects may occur at nicotinic recep- tors as well. Depending on the specific receptors involved, these effects may also be called antimuscarinic effects or an- tinicotinic effects. Definition of extrapyramidal symptoms (APA, 2022d): A group of adverse drug reactions attributable to dysfunc- tion of the extrapyramidal tract, such as rigidity of the limbs, tremors, and other Parkinson-like signs; dystonia (abnormal facial and body movements); and akathisia (restlessness). Ex- trapyramidal symptoms are among the most common side effects of the high-potency antipsychotics and have also been reported with the use of other drugs (e.g., SSRIs). Also called extrapyramidal syndrome (EPS). Definition of tardive dyskinesia (TD) (APA, 2022i): A movement disorder associated with the use of antipsychot- ics, particularly conventional antipsychotics that act primar- ily as dopamine- receptor antagonists. It is more common with prolonged use (months or years), and older patients, females, and patients with mood disorders are thought to be more susceptible. Symptoms include tremor; so-called
choreoathetoid movements; and spasticity of muscle groups, particularly orofacial muscles and muscles in the extremities. Onset is insidious and may be masked by continued use of the antipsychotic, only appearing when the drug is discontin- ued or the dose lowered. Its incidence is estimated at up to 40% of long-term users of conventional antipsychotics; the incidence is lower with atypical antipsychotics. No effective treatment is known. Older adults need special considerations for medications to treat schizophrenia. Older adults with schizophrenia often need adjust- ments to medication regimens with lower doses or divided doses throughout the day when possible (Sadock et al., 2015). The AGS releases and continually updates safety criteria to guide the treat- ment of the older adult population. The AGS (2019) recommends only patients with schizophrenia receive antipsychotic medication, which increases the risk of stroke, diminishes cognitive ability, and contributes to early death. The healthcare worker should investigate all medications being taken by the older adult with acute notation of antipsychotics drugs and their known side effects. Table 6 is a snapshot of anti- psychotic medication options and is presented to increase under- standing of decreased dose ranges and the comparative difficulty of side effect risk profiles for antipsychotics in older adults.
Table 6. A Snapshot of Decreased Older Adult Dosing and Side Effect Risk Profiles Drug Adult Dosage (mg/day) Geriatric Dosage (mg/day) Sedation Postural Hypotension
Anticholinergic Effects
EPS
TD
Clozaril (clozapine) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Haloperidol (Haldol)
300–450
12.5–25
High
Moderate
High
Low
Low
25–50
25
Moderate– high Moderate
Moderate
Moderate–high
Low
Low
150–750
50–200
Moderate
High
Low
Low
4–16
0.25–1.5
Low
Low
Low
Low
Low
1–15
0.25–0.5
Low
Low
Low
Very high
Yes
Note : Information taken from https://www.Medscape.com Neuroleptic malignant syndrome (NMS) is a life-threatening con- dition that can happen in response to antipsychotic medications. Early recognition and intervention are the most important things a healthcare worker can do for a patient experiencing NMS. The pri- mary symptoms of NMS are mental status changes, severe muscle rigidity, and autonomic changes (historically presenting with high fever ranging between 101 and 103 degrees Fahrenheit, tachy- cardia, and fluctuating blood pressure) (Boyd, 2017). Emergency intervention is needed for NMS. The healthcare worker should intervene as workplace policy dictates to get the patient to ap- propriate medical care as soon as possible. A delicate balance is needed to lessen problematic schizophren- ic symptoms and antipsychotic medication side effect profiles, which can be dangerous to the older adult. The healthcare worker can help assess the older adult with schizophrenia and seek to find interventions and treatments that can be modified if needed.
With an individualized plan of care and proactive planning, the healthcare worker can increase the quality of mental health ser- vices provided, in turn increasing the quality of life for the older adult living with schizophrenia. Self-Assessment Quiz Question #5 The healthcare worker is assessing the older adult taking anti- psychotic medication. What life-threatening condition warrants immediate attention?: a. Postural hypotension. b. Sedation. c. Anticholinergic effects. d. Neuroleptic malignant syndrome.
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Book Code: RPTX3024
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