I. Pharmacogenic psychiatric symptoms (i.e. paradoxical reactions).
1. Main manifestations.
(1) excessive sedation
Mostly due to an excessive amount of medication, several sedative drugs in combination, or improper dose adjustment for elderly and frail patients. The disease from the performance of excessive sleep, difficult to wake up, weakness and weakness.
(2) Mood depression
Most antipsychotic drugs can cause depressive states. Among them, haloperidol, chlorpromazine, reserpine, etc. are more common.
(3) Anxiety agitation
At the beginning of antipsychotic treatment, patients may experience insomnia, dreaminess, irritability, anxiety and restlessness, mostly in people with anxiety qualities. Among them, haloperidol, fenadine and vestrone are more common.
(4) Tension symptom group
Often there are extrapyramidal symptoms and increased muscle tone first, followed by muteness, dullness, until wood stiffness, and swallowing difficulties may occur. Often associated with excessive drug doses (including injection of long-acting agents), elderly patients are particularly susceptible.
(5) Delirium confusion
Both antipsychotics and anticholinergics can cause it.
(6) aggravate the original psychiatric symptoms.
2. Treatment measures.
(1) Identify in detail based on medical history, symptom characteristics, patient’s reaction, etc., and discontinue medication for observation if necessary.
(2) When there are obvious pharmacogenic psychiatric symptoms, measures should be taken to promote excretion, adequate infusion, vitamin B, C and other treatments.
(3) Use psychotherapy to provide comfort and explanation.
(4)Treatment of symptoms
Depressive state: when general treatment is ineffective, antidepressants such as SSRI class Zoloft, paroxetine, escitalopram, etc., and SNRI class duloxetine can be given.
Catatonic symptom group: give amantadine 100mg, 2 times/day. Disorders of consciousness, care should be taken to exclude comorbidities. For those caused by anticholinergic drugs, use 0.1% toxic lentiline 0.5-1ml, intramuscular injection, which can be repeated every hour until symptoms improve.
Second, acute extrapyramidal symptoms.
1, the main manifestations.
(1) tremor paralysis syndrome Generally seen in the early stage of treatment. The main manifestations are: pseudomask face, resting tremor, resting tremor, increased muscle tone, reduced movement, clumsy movements, small gait and salivation, etc. In severe cases, it may affect swallowing movements.
(2) Inability to sit still Most often occurs in the early stage of drug administration. The symptoms are: inability to sit still, inability to stand still, restlessness, pacing back and forth, and in severe cases, irritability and anxiety, and even aggravation of the original mental symptoms.
(3) Acute dystonia usually occurs within 48 hours of drug administration and is more common in adolescents. It is manifested as large strange movements of the face, tongue and neck, spasmodic slanting neck, motility crises (eye upward movement), corneal arch, twisting spasm, etc.
2.Treatment measures.
(1) Pay attention to the identification, reduce the use of antipsychotic drugs or add antagonistic drugs (such as Antan) to treat and observe if necessary.
(2) Use anti-tremor paralysis syndrome drugs for treatment
III. Delayed dyskinesia (TD).
1.Main manifestations
This symptom mostly appears after long-term use of antipsychotic drugs. Typical manifestations are involuntary movements of the buccal muscles, tongue muscles and masticatory muscles, resulting in sucking, lip smacking, tongue fiddling and other movements, known as the “mouth, tongue and cheek” triad.
2, treatment measures.
(1) Discontinue or change medication Once the delayed movement disorder appears, the medication should be promptly discontinued. For patients who still need to use antipsychotic drugs, they can be treated with drugs that have less extrapyramidal reactions, such as clozapine and methiodiazine.
(2) Drug treatment
(3) Prevention Avoid long-term high-dose medication. For patients taking medication for a long time, intermittent dosing can be adopted to prevent abrupt discontinuation of antipsychotic drugs and rational use of anti-Parkinsonian drugs. For middle-aged and elderly patients and patients with organic brain diseases, treatment should be closely observed.
1. Main manifestations
Most antipsychotics can cause epileptiform seizures.
2. Treatment measures.
(1) In patients who are sensitive to antipsychotic drugs, it is appropriate to use drugs with weaker convulsive effects, and the dose of antiepileptic drugs should not be increased too quickly, and the dose of antiepileptic drugs can be increased appropriately in patients who were already taking antiepileptic drugs.
(2) Anti-psychotic drug-induced epilepsy, if the frequency of seizures is very little, generally do not need to stop, but to combine anti-epileptic drugs, such as phenytoin sodium, 0.1g, 3 times / day, valproate sodium, 0.2g, 3 times / day.
(3) Patients with more severe and more frequent seizures should be discontinued or changed in a timely manner, and the acute phase should be treated according to the principles of epilepsy treatment.
V. Autonomic nervous system disorders.
1. Main manifestations
Because many antipsychotic drugs have anti-adrenergic effects, anticholinergic effects or stimulating adrenergic effects, a variety of autonomic nervous system side effects can occur. Specific manifestations include.
(1) Gastrointestinal symptoms Dry mouth, constipation, paralytic intestinal obstruction, etc.
(2) Eye symptoms Blurred vision, glaucoma.
(3) Genitourinary system symptoms Urinary retention, sexual dysfunction.
(4) Cardiovascular system symptoms Postural hypotension, cardiac rhythm disturbance, myocardial damage.
(5) Decreased sweating, cooling and nasal congestion, etc.
2.Treatment measures.
(1) Drug reduction, drug discontinuation or drug change treatment.
(2)Symptomatic treatment
Dry mouth: drink small amount of water, gargle often, or chew bubble gum, etc.
Constipation: Move more, eat more fiber-containing food, avoid unnecessary use of anticholinergics, and use laxatives if necessary.
Paralytic intestinal obstruction: fasting, gastrointestinal decompression, anal venting, high-pressure enema. Apply intestinal motility agents, such as neostigmine, 0.5-1 mg, intramuscularly, 2 times/day. Administer antibiotics to prevent infection and closely monitor for complications.
Blurred vision: If necessary, use pupil constrictor to spot eyes.
Glaucoma: stop the drug immediately and consult the ophthalmologist.
Urinary retention: bladder massage or hot compress to promote discharge in mild cases, catheterization is required in severe cases, acupuncture point stimulation is also available.
Postural hypotension: should be taken in a lying position with head down. If recovery is not possible, apply norepinephrine, m-hydroxylamine and other antihypertensive drugs that excite the a-receptors. Patients should be informed to move gently when getting up or standing while taking the medication, and to sit down immediately when dizziness and black eyes occur. Epinephrine should not be used because then the a-receptors are inhibited and the b-receptors are excited, causing vasodilation and even lower blood pressure.
Arrhythmias: Treat as arrhythmias, with 10-20mg of Procaine 3 times/day for mild cases. Procainamide for ventricular premature beats, 0.5g, 3 times/day. Stop the drug promptly when paroxysmal tachycardia occurs. For atrial tachycardia caused by phenothiazines, dissolve 0.4mg in 25% glucose solution 20ml with cetiran and inject slowly by sedation. For paroxysmal ventricular tachycardia, use lidocaine 50~l00mg in 25% glucose 20ml and slowly inject intravenously.
Myocardial damage: closely observe the electrocardiogram changes, discontinue the drug if necessary, give vitamin B1, potassium chloride, energy combination, etc.
Six, malignant symptom group.
1, the main manifestations.
(1) The appearance of indifferent expression, little movement, reticence similar to wood stiffness, or the appearance of excitement and agitation.
(2) Unexplained fever, fever of 38℃ or more for 12 consecutive hours, and delirium confusion may accompany high fever.
(3) Extrapyramidal symptoms, such as myotonia, motor inability, tremor, dysphagia, motility crisis, etc.
(4) Autonomic symptoms, such as facial flushing, tachycardia, profuse sweating, salivation, seborrhea, difficulty in urination and rapid decubitus ulcers and other neurotrophic disorders.
(5) Severe cases have impaired consciousness, peripheral circulatory failure, dehydration and nutritional disorders, which can lead to death if not treated in time.
2.Treatment measures.
(1) Discontinue antipsychotic drugs immediately.
(2) It is advisable to take physical cooling in case of high fever, and also to make antipyretic agents.
(3) Rehydration fluid first infusion of salt liquid, followed by sugar liquid.
(4) Appropriate use of anti-tremor paralysis syndrome drugs to improve the extrapyramidal system
(5) Control or prevent infection.
(6) Use of adrenocorticosteroids to improve stress function.
VII. Digestive system symptoms.
1. Main manifestations.
(1) Gastrointestinal reactions Dry mouth, thirst, nausea, vomiting, loss of appetite, feeling of fullness in the upper abdomen, diarrhea, constipation and intestinal paralysis. Most patients can disappear on their own during the course of treatment; if they persist, other diseases should be considered.
(2) It can cause pharmacogenic liver function damage.
2.Treatment measures.
(1) Toxic liver damage should be immediately discontinued. Check liver function frequently. Allergic liver damage can first reduce the drug.
(2) Apply detoxifying and hepatoprotective drugs such as heparin and hepatol.
(3) Supplement with glucose, high protein diet, vitamin class.
(4) Apply coenzyme A and adenosine triphosphate and symptomatic treatment.
(5) For those with obvious allergy or severe hepatitis, use adrenocorticosteroids.