See also: Psychosis
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Positive & Negative Symptom Management
Positive Symptoms:
- Hallucinations, delusions, thought disorder.
- Often managed by First-Generation Antipsychotics (FGAs) which block dopamine D2 receptors.
Negative Symptoms:
- Flat affect, anhedonia, avolition, alogia.
- Second-Generation Antipsychotics (SGAs) (blocking both D2 and 5-HT2A) may have better efficacy for these symptoms.
Precautions and Counseling Points
FGAs
- Monitor closely for EPS (dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia)
- NMS
- Hyperprolactinemia
- Use caution in patients with cardiac arrhythmias (QT prolongation).
- Counsel to report muscle stiffness or tremors early.
SGAs - Higher risk of metabolic side effects (weight gain, dyslipidemia, hyperglycemia, T2DM).
- Emphasize diet, exercise, and routine metabolic monitoring (BMI, lipids, glucose).
- Some risk of EPS/hyperprolactinemia (e.g., risperidone)