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The history of the discovery of the first antipsychotic medication is very interesting and marked a milestone in the history of medicine. In the 1950s, a patient was being treated surgically and was given chlorpromazine as a tranquilizer to induce anesthesia. The patient was showing symptoms of psychosis, with a history of maintaining positive symptoms, however, after coming out of anesthesia, it was noted that the individual remained free of hallucinations and delusions for several days. This is how the first-generation of antipsychotics were born. Four years later, Clozapine emerged with great benefits due to its few side effects and much less action on dopamine receptors. (Saloni Dattani & Roser, 2024)
But as more generations of antipsychotic medications emerged to treat disorders as complex as schizophrenia, we also had to deal and understand all the adverse side effects that accompany these medications. Some of these effects can be life-threatening. (9 Side Effects of Antipsychotic Medications, n.d.)
To begin, we must mention one of the most frightening side effects of antipsychotics, the neuroleptic malignant syndrome (NMS). It is a complex number of symptoms, such as motor, autonomic, shift in cognitive function, and fever. Fever may be variable, low-grade or present as true hyperpyrexia. NMS can lead to severe complications, such as muscle rupture, severe acute kidney failure and death. That’s why it’s important for the practitioner to be familiar with this type of side effect, know how to recognize it and how to intervene immediately. First, it is imperative to discontinue the medication that caused the side effect. The most often offending drugs are the dopamine receptor interrupters as haloperidol, fluphenazine, chlorpromazine, however, it may also happen with other antipsychotics as risperidone, olanzapine and clozapine. The provider should know that it is a true emergency, which sometimes requires cardiovascular and respiratory support. It is crucial to curve the symptoms as soon as possible. Medications of choice to treat this horrific side effect are dantrolene or bromocriptine. The patient and authorized family should be educated by the provider about these possible side effects, whenever and wherever treatment with these medications begins. (Berman, 2021)
Other possible life threating side effect can be tardive dyskinesia (TD). It is a condition of repeated involuntary movements that can become irreversible and disabling for the individual with long-term use of antipsychotic medications. The most related medications to this disorders are older antipsychotics previously mentioned. It is important for the health care provider to know how to immediately recognize TD and treat it promptly. In most cases, the medication causing the side effect must be discontinued.
