MAINTENANCE THERAPY
Two antipsychotics are available in depot injection
forms for maintenance therapy: fluphenazine (Pro-
lixin) in decanoate and enanthate preparations, and
haloperidol (Haldol) in decanoate. The vehicle for
depot injections is sesame oil; therefore, the medica-
tions are absorbed slowly over time into the client’s
system. The effects of the medications last 2 to 4 weeks,
eliminating the need for daily oral antipsychotic
medication (see Chap. 2). The duration of action is
7 to 28 days for fluphenazine and 4 weeks for halo-
peridol. It may take several weeks of oral therapy
with these medications to reach a stable dosing
level before the transition to depot injections can be
made. Therefore, these preparations are not suit-
able for the management of acute episodes of psy-
chosis. They are, however, very useful for clients re-
quiring supervised medication compliance over an
extended period.
SIDE EFFECTS
The side effects of antipsychotic medications are sig-
nificant and can range from mild discomfort to per-
manent movement disorders (Marder, 2000). Be-
cause many of these side effects are frightening and
upsetting to clients, they are frequently cited as the
primary reason why clients discontinue or reduce the
dosage of their medications. Serious neurologic side
effects include extrapyramidal side effects (acute dys-
tonic reactions, akathisia, and parkinsonism), tardive
dyskinesia, seizures, and neuroleptic malignant syn-
drome (discussed below). Non-neurologic side effects
include weight gain, sedation, photosensitivity, and
anticholinergic symptoms such as dry mouth, blurred
vision, constipation, urinary retention, and ortho-
static hypotension. Table 14-2 lists the side effects
of antipsychotic medications and appropriate nurs-
ing interventions.Extrapyramidal Side Effects.Extrapyramidal side
effectsare reversible movement disorders induced
by neuroleptic medication. They include dystonic re-
actions, parkinsonism, and akathisia.
Dystonic reactionsto antipsychotic medica-
tions appear early in the course of treatment and are
characterized by spasms in discrete muscle groups
such as the neck muscles (torticollis) or eye muscles
(oculogyric crisis). These spasms also may be accom-
panied by protrusion of the tongue, dysphagia, and
laryngeal/pharyngeal spasm that can compromise
the client’s airway, causing a medical emergency.
Dystonic reactions are extremely frightening and
painful for the client. Acute treatment consists of
diphenhydramine (Benadryl) given either intramus-
cularly or intravenously, or benzotropine (Cogentin)
given intramuscularly.
Pseudoparkinsonismor neuroleptic-induced
parkinsonism includes shuffling gait, masklike facies,14 SCHIZOPHRENIA 303
Table 14-1
ANTIPSYCHOTICDRUGS, USUALDAILYDOSAGES, ANDINCIDENCE OFSIDEEFFECTS
Usual Daily
Generic (Trade) Name Dosage* (mg) Sedation Hypotension EPS AnticholinergicCONVENTIONAL ANTIPSYCHOTICS
Chlorpromazine (Thorazine)
Trifluoperazine (Trilafon)
Fluphenazine (Prolixin)
Thioridazine (Mellaril)
Mesoridazine (Serentil)
Thiothixene (Navane)
Haloperidol (Haldol)
Loxapine (Loxitane)
Molindone (Moban)
Perphenazine (Etrafon)
Trifluoperazine (Stelazine)
ATYPICAL ANTIPSYCHOTICS
Clozapine (Clozaril)
Risperidone (Risperdol)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)200–1,600
16–32
2.5–20
200–600
75–300
6–30
2–20
60–100
50–100
16–32
6–50150–500
2–8
5–20
150–500
40–160 mg++++
++
+
++++
++++
+
+
+++
+
++
+++++
+++
+++++++++
++++
+
+++
++
+
+
++
+/0
++
+++
++
+++
++++
+/0++
+
++++
+
+
++++
++++
+++
+
+++
+++++/0
++
+
+
+++++
+++
++
+
+/0
++
++
+
+++
+
++
+
+*Oral dosage only
EPS, extrapyramidal side effects
++++, very significant; +++, significant; ++, moderate; +, mild; +/0, rare or absent