Antipsychotics can produce side effects in many ways, which can vary depending on the type of drug, the dose or the individual patient, but most have common side effects, some appearing in the short term after medication, and some appearing after long-term use.
1. The anticholinergic and antiadrenergic effects of drugs cause the following side effects.
Dry mouth, blurred vision, constipation, urinary retention, increased heart rate, obesity, menstrual disorders and lactation, etc.
2. Neurological symptoms.
Extrapyramidal symptoms are prominent. Acute dystonia, inability to sit still and Parkinson’s syndrome can occur with short-term use of the drug; long-term use of the drug can lead to delayed movement disorders.
Acute dystonia is most common in adolescents, especially with fluoride-based antipsychotics, and occurs within a few days of drug administration. The symptoms can be rapidly relieved by intramuscular injection of scopolamine hydrobromide 0.3-0.5mg.
Akathisia: The incidence of Akathisia is 20-40%, mostly in middle-aged women, and it occurs in the second to third week of drug administration. It is characterized by restlessness, inability to sit or lie still, repeated walking or walking in place, and may be accompanied by involuntary movements. The treatment is the same as acute dystonia, and valium or insulin can be tried.
③ class Parkinsonian syndrome (Parlinsoniansydrome): very common, to women and elderly patients prone to occur, characterized by slow movement or motor inability, resting tremor and increased muscle tone. Anticholinergic drugs are effective. The above symptoms are reversible and can disappear if the drug is stopped or reduced.
Delayed dyskinesia (Tardivedyskinesia): It is a specific and long-lasting extrapyramidal reaction caused by long-term high dose of antipsychotic drugs, which may occur only after 3 months of medication, with an incidence of 15% to 40%, more in women than in men. The most common one is the buccal trismus (BLM syndrome), which can cause slurred speech and affect eating in severe cases.
It can also be manifested as involuntary swaying of the limbs, dancing finger-like movements, tachycardia or twisting of the limbs and trunk. In addition to prevention, early detection and early treatment are especially important. Some people use levodopa as “desensitization” treatment, and the symptoms worsen within a short period of time, but after 2-3 weeks of discontinuation, the symptoms gradually improve. At present, there are no effective measures.
3. Skin symptoms.
They are usually caused by allergy and occur in the first to fourth week of treatment, and generally appear as red papules, starting on exposed areas such as hands and face, but also extending to the trunk, with symmetrical distribution, and in severe cases, herpes, exfoliative dermatitis, skin erosion, etc. The drug should be discontinued immediately.
4. Liver damage.
The incidence of biliary depression jaundice due to chlorpromazine etc. is about 0.1%. Jaundice free hepatitis is more common. It is caused by allergy and can be recovered in 1 to 2 weeks after discontinuation of the drug, and should be clinically distinguished from infectious hepatitis.
5, digestive system symptoms.
Drug-induced decrease in smooth muscle tone. It can cause paralytic intestinal obstruction, which is likely to occur in long-term overdose.
6, cardiovascular system symptoms.
Postural hypotension is common, mostly seen at the beginning of treatment, especially in the first week after the drug, and is related to the drug blocking the peripheral alpha-adrenergic receptors. Tachycardia and ECG abnormalities are quite common, mainly manifested as S-T segment depression, Q-T prolongation, T-wave widening or inversion? and symptomatic treatment.
7. Side effects of the hematopoietic system are less common.
The incidence of drug-induced granulocytopenia is 0.1% to 0.7%, with a high rate due to clozapine, which is a metabolic immune reaction. Early diagnosis, timely treatment, the prognosis is mostly good, but serious cases and improperly treated may cause death.
8.Other.
Malignant syndrome (Malignantsyndrome) is a serious side effect. Most of the drugs appear after a large number of manifestations of high fever, tremor, muscle tonicity, swallowing difficulties and other extrapyramidal symptoms, tachycardia, sweating, urinary difficulties, blood pressure fluctuations and other vegetative symptoms, some patients are accompanied by impaired consciousness. The course of the disease is acute, and improper management can lead to figuration. Jiang Zonin (1988) reported that sudden death during the antipsychotic treatment period accounted for 3.9% of all hospital deaths during the same period, of which mechanical asphyxia from various causes accounted for about 1/3. However, in some patients with sudden death, autopsy did not reveal a causative etiology.