Schizophrenia is due to a disturbed and hyperactive dopaminergic signal pathway. 

Both drugs are typical antipsychotics.  Both have EPSE and sedative effects, however Chlorpromazine has more AE, including: weight gain, hypotension and antimuscarinic effects.  

• At low doses there is a decreased likelihood of significant AEs.  
• Typical antipsychotics are sedatives which can improve QoL of dementing patients.
• Anticholinergic side effects include urinary retention, which is useful in counteracting incontinence.

Atypical antipsychotics have far fewer EPSE.  

They are more likely to cause disordered metabolism, leadin to weight gain, insulin resistance.  

They are mostly sedatives.

They are very expensive.

Haloperidol has significant EPSE, but few other side effects.  It is relatively cheap.

Clozapine has almost no EPSE, but will cause sedation, hypotension, anticholinergic symptoms and weight gain.  It is rather expensive.

Akathisia- restlessness and irritability

Dystonia - rigidity 

Parkinsonism - bradykinesia, shuffling gate, cog wheel rigidity 

Tardive dyskinesia - abnormal, involuntary movements

EPSEs can be treated with either antimuscarinic (anticholinergic) agents such as Benztropine (Congentin).  It antagonizes ACh and balances effect of dopamine.

Pramiprexole is a dopamine agonist and can be used to treat EPSE.

Neuroleptic malignant syndrome.  It is characterised by hyperpyrexia, altered LOC and rigidity.

Classically NMS has very high creatine kinase.

Both drugs are equally effective in treating depression.

TCAs are associated with significantly more AEs including anticholinergic effects, antihistaminergic and cardiotoxic.  Severly sedative.

SSRIs are more heavily associated with headaches, agitation and tremours.

Both cause sexual dysfunction.  SSRIs cause ejaculatory delay.

TCAs are indicated in in-patient management and severe, resistant depression.

Paroxetine has a significant sedative effect where as fluoxetin (Prozac) can induce anxiety and hyperactivity.

Fluoxetine is infamous for causing sexual dysfunction and weight loss.  Contraindicated in hepatic impairment.

Both are indicated in the treatment of MDD.

The manic episodes of bipolar disorder.  As well as prophylactically to prevent the onset of mania in schizophrenia.   

The classical patient is the resistant bipolar patient who has tried without success 6 months of mood stabilizing anticonvulsants (Carbemazepine).

SSRI morning

TCA evening

Serotonin withdrawal

MAOi and SSRI polypharmacy

Clinically: tremour, hyperthermia and cariovascular symptoms.

Carbamazepine works by decreasing the excitability of the neuronal cells by altering the permeability of the membranes.

Carbamazepine is indicated as second line management of bipolar disorder.  It is most effective in rapid cycling bipolar or a schizoaffective picture.

Maintenance with Lithium.  Plus an additional mood stabiliser, potentially sodium valproate.

Second line treatment, may respond better to antipsychotics.

To manage symptoms while medications begin to work, use benzodiazepines.

Omega 3 fatty acids have some evidence to suggest benefit to negative symptoms.

 Oxazepam or Temazepam would be preffered in the elderly, as they are short acting.  

High potency and long acting are not recommended in the elderly i.e. Triazolam and Alprazolam

Gabapenin is used for the relief or neuropathic pain, seizures and bipolar.

Gabapentin shares the family AEs of antianxiety drugs.  Sedation, dizziness, drowsiness, drooling, respiratory depression, peripheral edema.  Increased risk of suicidal tendencies.  Risk of withdrawal and abuse leading to OD.

Anticholinergic is constipation, blurred vision, urinary retention, tachycardia, dry mouth and memory impairment.  Caused by antihistamines, antiparkinsons, antidepressant and antipsychotics.

Cholinergic: SLUDGE salivation, lacrimation, urination, diarrhea, GIT upset, emesis.

Prescription drug overdoses.  Pseudoephidrine, beta blockers, antoconvulsants.  

Diaphoresis, anxiety, seizures, hyperreflexia.