Schizophrenia Q 44
An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used for this client to treat:
A. Dyskinesia
B. Dementia
C. Psychosis
D. Tardive dyskinesia
Correct Answer: C. Psychosis
By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is a first-generation (typical) antipsychotic medication that is used widely around the world. Food and Drug Administration (FDA) approved the use of haloperidol is for schizophrenia, Tourette syndrome (control of tics and vocal utterances in adults and children), hyperactivity (which may present as impulsivity, difficulty maintaining attention, severe aggressivity, mood instability, and frustration intolerance), severe childhood behavioral problems (such as combative, explosive hyperexcitability), intractable hiccups.
Option A: Levodopa therapy is typically the cause of dyskinesias, but other drugs such as dopamine agonists, COMT (catechol-o-methyltransferase) inhibitors and MAO-B inhibitors can worsen dyskinesias. Because they tend to occur at peak concentrations of levodopa, one management strategy is to reduce dopamine levels. This can be done with small decreases in levodopa dosage or by removing other dopaminergic medications (e.g., dopamine agonists, COMT inhibitors or MAO-B inhibitors).
Option B: FDA approved medications to improve cognitive functions include cholinesterase inhibitors and memantine. Cholinesterase inhibitors are donepezil, galantamine, and rivastigmine. Cholinesterase inhibitors prevent the breakdown of acetylcholine and can slow or delay the worsening of symptoms. Memantine is an NMDA agonist and decreases the activity of glutamine. Donepezil is approved for all stages of Alzheimer disease, galantamine, and rivastigmine for mild to moderate stage and memantine for moderate to severe stage.
Option D: Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction. Primary prevention of tardive dyskinesia includes using the lowest effective dose of antipsychotic agent for the shortest period possible. However, if tardive dyskinesia develops, it is recommended to decrease the dose or even discontinue the offending agent and switch to clozapine. Clozapine is recommended in patients with tardive dyskinesia who continue to require antipsychotics as the incidence of tardive dyskinesia with clozapine is significantly less than other antipsychotics.