Editing Mental Health and Psychosocial Nursing (section)

=== Antipsychotics ===
'''First generation''' (haloperidol, fluphenazine, chlorpromazine): strong dopamine blockade, more extrapyramidal symptoms. '''Second generation''' (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, paliperidone, lurasidone, clozapine): fewer extrapyramidal symptoms, more '''metabolic syndrome''' (weight gain, dyslipidemia, hyperglycemia). Monitor weight, waist circumference, fasting glucose or A1C, and lipids.

'''Extrapyramidal symptoms''':
{| class="wikitable"
! Type !! Typical onset !! Features !! Management
|-
| Acute dystonia || Hours to days || Torticollis, oculogyric crisis, opisthotonos, '''laryngospasm''' || Emergency; IM/IV diphenhydramine or benztropine
|-
| Akathisia || Days to weeks || Inner restlessness, inability to sit still; often mistaken for agitation and linked to suicide risk || Reduce dose, propranolol, benzodiazepine
|-
| Pseudoparkinsonism || Weeks || Shuffling gait, mask facies, pill-rolling tremor, cogwheel rigidity, bradykinesia || Anticholinergic agent, dose reduction
|-
| Tardive dyskinesia || Months to years || Involuntary lip smacking, tongue protrusion, choreoathetoid movements; may be irreversible || Screen with AIMS, switch agent, valbenazine or deutetrabenazine
|}

'''Neuroleptic malignant syndrome''': a life-threatening reaction developing over days. '''Hyperthermia, "lead-pipe" muscular rigidity, autonomic instability, altered consciousness, and markedly elevated creatine kinase with myoglobinuria and risk of acute kidney injury.''' Stop the antipsychotic immediately, cool aggressively, hydrate, and expect dantrolene or bromocriptine. Contrast with serotonin syndrome, which is faster in onset and features hyperreflexia and clonus rather than lead-pipe rigidity.

'''Clozapine''' is reserved for treatment-resistant schizophrenia and reduces suicidality, but requires '''absolute neutrophil count monitoring for agranulocytosis'''; report fever, sore throat, or flu-like symptoms immediately. Also causes myocarditis, seizures at higher doses, orthostatic hypotension, sialorrhea, and '''severe constipation and ileus''' that can be fatal. Assess bowel function routinely.