“A Study of Common Adverse Drug Reactions in Psychiatric Patients Treated with Typical & Atypical Antipsychotics”

Arana,2000). Longterm dopamine receptor The objective ofthis stuaj is Cn'tical anabsis ofAdverse blockade leads to supersensitivity to doparnine Dmg Reactions f l DR) associated with gpicaland awical and result in tardve dyskinesia(Glazer,2000). DA blockade in hypothalamus results in antipsycholics. 100 patients on treatment with gpical antipsy1.hotics, a~pical antipychotics and combinations of hyperprolactinemia, galactorrhea, amenorrhea and @uL and apicals were obmedfor occurrence o f A D R sexual dysfunction (Zarate,2000). The horn 1" ahy o f initiation 4 therapy ti// their dis~. harge, anticholinergic effects of chlorpromazine(CPZ) once in everyfive days. Data was obtained by interviewing causes ADR such as blurred vision, dry mouth, sedation, constipation and urinary hesitancy.In and examining the patient, from the treating pLysi~ians and reviewing the medical recordr. Anahsis of the adlt ion the alpha adrenergic blocking property collected data showed that b l u h g o f virion and tigidig of CPZ may result in orthostatic hypotension, palpitation, inhibition of ejaculation. High doses were more pronoun~. ed with typz~ul antpgchotil. ~ while inlreased uppelhe, weight guin were more with patients directly depress the heart and produce Q-T prolongation and suppression of T-wavewelch taking agpical antzpgchotics. & Chue ,2000) Keywotds:Typical Antipsychotics Atypical Antipsychotics T h e newer antipsychotic drug, clozapine, olanzapine and resiperidone are less prone to Adverse Drug Reactions. produce side effects like EPS unlike conventional INTRODUCTION antipsychotics and so are very frequently prescribed nowadays. However many patients an tipsych0tic drugs like develop different types of adverse effects to these phenothiazines(eg:chlorpromazine) lnd drugs also.For example, clozapine which exerts bu~ro~henones(eg:halo~eridO1) are its action through 5-HT 2, muscarinic and a lph with a wide range unwanted effects' Their adrenergic receptor blockade is found to give rise through dopamine in to adverse effects like sedation(Stanniland & the brain,also gives rise to extrapyramidal Taylor,2000), hypersalivation(Ben Aryeh et symptoms (EPS) ( K a ~ u r e t a1,2000)' The d,J996), orthostatic & r ~ e s s ~ u u n ~ n et @OfjO) common EPS encountered are drug induced tachycardia, urinary hesitancy(Ful1er et al, parhnsonism, muscular dystonias, akathisia (Blin 1996). The most serious problem with clozapine et a1,1996), neuroleptic malignant syndrome is the occurrence of agranulocytosis and blood ***' CRRl, "'ASSOCIATE PROFESSOR, ** PROF OF PHARMACOLOGY, ' PROFESSOR OF PSYCHlATRY F5.G INSmLm OFMEDICALSCIENCESAND RESEARCH, COWTORE dyscrasias (\.\forre1 et a1,2000) though it occurs in a very small percentage of patients.Another atypical antipsychotic, olanzapine, causes very few EPS, but weight gain is a commonly reported side effectwnon et a1,2001). Risperidone, yet another atypical antipsychotic also g v e to adverse effects because it causes blockade of alpha 1, alpha 2 receptors, H I and 5-HT, receptors (Conley,3000). ADRs like drowsiness, lethargy and confusion in the first two weeks of treatment are reported both with typical and atypical antips)rchotics. Thus, though the atypical antipsychotics are less likely to produce side effects like EPS and therefore improve patient compliance at least in the initial days of therapy, they also lead to problems like weight gain which may also hinder long term compliance. So the newer drugs also need to be evaluated systematically for the occurrence of adverse effects and their safety profiles need to be studied to see whether they are significantly dfferent from conventional an tipsycho tics. AIMS OF T H E PRESENT STUDY: Comparison of profiles of ADR of atypical antipsychotics with those of typical antipsychotics MATERIALS A N D METHODS: This study was conducted a t Department of Psychiatry, PSG IMS & R,Coimbatore SELECTION OF PATIENTS: A total of 100 patients who were admitted consecutively in the wards for psychtric treatment with atypical, typical and combination of both antipsychotics were selected. OBSERVATION: Medication of patients with atypical and typical antipsychotics were entered in a proforma. Information regarding the drugs, prescribed dosage schedule, route of administration and duration of therapy were collected from medcal records. Changes in medication were continuously followed once in every five days till discharge. ADR MONITORING: The patients were closely observed for ADR. The information were collected once in 5 days from 1. Patient through h e c t interview 2. Treating physician 3. Lab investigations. 4. Hospital records Every patient was observed from the first day of initiation of drug therapy till discharge. ANALYSIS: Comparative analysis o f ADR of atypical antipsychotic & typical antipsychotics was done by SPSS programme from the data regarding medication o f each patient.Percentage of incidence of each adverse effect was calculated for indvidual antipsyc11otics.The same analysis was repeated after grouping patients getting (1) Typical antipsychotics alone (2)Atypical antipsychotics alone (3)Combination of typical & atypical antipsychotics.Ch~-square test was performed to look for significant differences in the adverse effects between patients taking typical an tipsycho tics and atypical an tipsychotics. Table No. l Sex Distribution of the Study Population RESULTS Description of Study Populatiom(Tab1e 1) Out of 100 inpatients, 58 were males and 42 females. The mean age of males was 35 yrs. and females was 34 yrs. DRUGS INCLUDED IN THIS STUDY : Typical antipsychotics Haloperidol(HAL),Chlorpromazine( CPZ) Atypical antipsyhcoticsOlanzapine(OLA), hsperidone(RIS), Clozapine(CL0) Details about the dosage and duration of use are gven in Table 2 -