As we delve deeper into the world of antipsychotic medications, it is crucial to understand the precautions and contraindications associated with their use. While these medications can be highly effective in treating psychosis, certain medical conditions require caution when taking antipsychotics. Additionally, specific considerations must be made for different groups of individuals, such as older adults and expectant or new mothers.
One must first be aware that antipsychotics should be used cautiously in individuals with certain medical conditions. These include:
- Cardiovascular diseases
- Liver or kidney impairment
- Diabetes
- Hypothyroidism
- Parkinson’s disease
- Epilepsy
- Depression
- Myasthenia gravis (a disease affecting nerves and muscles)
- An enlarged prostate
- A history of glaucoma, an eye disease (see above)
- Lung disease with breathing problems
- Some blood disorders
- Antipsychotics should not be given to people with phaeochromocytoma (a type of tumour causing very high blood pressure) or anyone in a state of impaired consciousness, such as a coma
The reason behind this caution lies in the potential side effects that antipsychotics may exacerbate or interact with these pre-existing conditions. Therefore, it is essential for healthcare providers to carefully evaluate each individual’s medical history before prescribing antipsychotic medications.
Another group that requires particular attention when considering antipsychotic use is older adults. Due to age-related changes in metabolism and organ function, older people may experience a heightened sensitivity to the side effects of these medications. This includes an increased risk of falls due to dizziness or sedation caused by antipsychotics. Hence, healthcare professionals should exercise caution when prescribing these drugs to elderly patients and closely monitor their response.
For expectant or new mothers dealing with schizophrenia or other psychotic disorders, there are additional considerations regarding the use of antipsychotics during pregnancy and breastfeeding. It is important to note that untreated psychosis can have negative consequences for both mother and child; however, medication safety during pregnancy remains a concern.
While there are limited studies on the effects of newer atypical antipsychotics on pregnancy outcomes compared to traditional ones (typical), some evidence suggests a potential risk of birth defects with certain atypical agents during early pregnancy. However, abruptly stopping medication can also lead to a relapse into psychosis, which can have significant consequences. Therefore, the decision to use antipsychotics during pregnancy should be made on a case-by-case basis, weighing the potential risks against the benefits.
When it comes to breastfeeding, most antipsychotics are present in breast milk but at relatively low levels. However, it is crucial to consider the individual drug’s half-life and its impact on the infant’s central nervous system. Healthcare providers should carefully assess the risks and benefits of continuing or discontinuing antipsychotic treatment while breastfeeding to ensure the well-being of both mother and child.
By understanding these precautions and contraindications, healthcare providers can optimise treatment plans for individuals with psychosis while minimising potential harm. It is crucial for patients to communicate openly with their healthcare team about their medical history, concerns, and goals so that together they can make informed decisions regarding antipsychotic therapy.