antipsychotic and antiepileptic agents

epilepsy pathology

excessive electrical discharge

• motor cortex- muscle convulsion

• hypothalamus- autonomic changes

• reticular formation (brainstem)- loss of consciousness

research suggests that increased excitation or reduced inhibition can be the cause

• overactive in glutamate, inhibition mechanisms can be reduced (GABA)

generalized seizures

tonic-clonic, tonic, clonic, absence, atonic, myoclonic

tonic-clonic (grand mal)

loss of consciousness, sustained contraction of all muscles followed by powerful rhythmic contractions

tonic

generalized sustained muscle contractions throughout the body, loss of consciousness

clonic

rhythmic, synchronized contractions throughout the body, loss of consciousness

absence

abrupt brief loss of consciousness, motor components may be present

atonic

brief reduction in muscle tone in the head or neck, one limb, or throughout body

myoclonic

sudden brief shock like contractions of the face, trunk, or extremities

focal seizures

• originate locally and end locally within a hemisphere

• simple-partial, complex, secondary

simple-partial

no impaired consciousness, motor symptoms in face, arms, or legs, hallucinations, autonomic nervous response

complex

loss of consciousness may occur, wide variety with other manifestations, bizarre behaviors

secondary

progressively increase to a bilateral, convulsive seizure, including tonic, clonic, or tonic-clonic components

epilepsy pre-seizure symptoms

emotional stress, sleep deprivation, flashing lights, recent illness, drugs, alcohol withdrawal, fever

epilepsy symptoms during seizure

aura, rhythmic behavior, tonic movements, clonic movements, incontinence, tongue biting, rhythmic flexion and extension of limbs

epilepsy post-seizure symptoms

confusion, fatigue in partial seizure, focal weakness/sensations, headache, physical injury, hypoglycemia

barbiturates

• barbital

• used for epilepsy

• ADRS

  • sedation, nystagmus, ataxia, folate deficiency (cancer risk), vitamin K deficiency (bleeding risk)

benzodiazepines

• cam/pam

• used for epilepsy

• ADRS

  • sedation, ataxia, behavioral changes

hydontoins: decreases sodium entry

• foshphenytoin (cerebyx), phenytoin (dilantin)

• used for epilepsy

• ADRS- less tolerated

  • GI irritation, confusion, sedation, dizziness, headaches, cerebellar signs and symptoms, hirsutism (excessive hair growth)

iminostilbenes: slows recovery of sodium channels

• azepine

• used for epilepsy

• ADRS

  • dizziness, drowsiness, ataxia, blurred vision, anemia, water retention, arrythmias, CHF

succinimides: decreases calcium influx

• ethosuximide (zarontin)

• used for epilepsy

• ADRS

  • GI distress, headache, dizziness, fatigue, lethargy, dyskinesia, bradykinesia, skin rashes

valproprates: limit sodium influx and increase GABA levels

• valpro

• used for epilepsy

• ADRS

  • GI distress, temporary hair loss, weight gain or loss, impaired platelet function (bleeding risk)

second generation epilepsy medications

• newer medications that have more predictable pharmacokinetics with fewer side effects but not as effective in treatment

• ADRS

  • sedation, ataxia, fatigue, dizziness, headache, vision problems, weakness, nausea, psychiatric disturbances, confusion, incoordination

PT for epilepsy

is the patient at risk for a seizure during therapy, in there potential triggers in the environment, is their medication working, are there ADRS present, sedation and dizziness can affect therapy, cerebellar ADRS can affect therapy

psychosis pathology

changes in the dopamine system

• subcortical underactivity and frontal cortex over activity

• GABA inability to control excitatory glutamate

schizophrenia symptoms

• positive

  • hallucinations, delusions, paranoia, bizarre behavior

• cognitive dysfunction

  • reduction in attention and executive function

• negative

  • anhedonia (unable to experience joy), asociality (isolate themselves from other), alogia (stop talking)

schizophrenia pharm ADRS

• metabolic effects

  • hyperlipidemia, weight gain, diabetes mellitus, cardivascular decline, endocrine problems

• sedation

• anticholinergic effects

  • blurred vision, dry mouth, constipation, urinary retention

extrapyramidal side effects (EPS) (dopamine blockade)

akathisia, parkinsonism, dyskinesia and dystonia, tardive dyskinesia, neuroleptic malignant syndrome

PT for schizophrenia

patients are likely to have cardiac abnormalities, obesity, diabetes, and high cholesterol

• metabolic syndrome

thermoregulation

• patients core body temp will be higher, but sweating will not increase

• be aware of any change in motor function