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Understanding Psychosis

Psychosis and culture

Explore and compare different medications below so you and your healthcare team can decide which medication is best for you.

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Amisulpride

Solian, Solprix
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Stiff or shaky muscles
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Amisulpride

Solian, Solprix
🏃
Supports motivation/interests
⚖️
Low risk of weight gain

Amisulpride carries a higher risk of hormonal side effects, especially in younger people, so it can be harder to use this medicine in adolescents and young adults. Amisulpride is sometimes used in combination with other antipsychotics such as clozapine.

Flip to show side effects

Aripiprazole

Abilify, Aripiprazole generic health
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Stiff or shaky muscles
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Aripiprazole

Abilify, Aripiprazole generic health
Not sedating, increased alertness
⚖️
Very low risk of weight gain
😀
Supports positive mood

Aripiprazole carries a very low risk of weight gain and hormonal side effects. Sometimes it is even used to manage these side effects caused by other antipsychotics. It can help people feel more alert, which may be a good thing, but can also make falling asleep difficult. Restlessness can also be a problem, especially in the first few weeks after starting aripiprazole but it improves with time for most people.

Flip to show side effects

Chlorpromazine

Largactil
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Chlorpromazine

Largactil
😌
Calming
😴
Helps with falling asleep

Chlorpromazine is the oldest antipsychotic. It was discovered in 1950 by accident during a search for new antihistamines (medicines for allergy). It is usually quite sedating, which can be helpful for sleep and calming effects - but not so good if this affects daily activities. It may cause dizziness and hormonal side effects.

Flip to show side effects

Clozapine

Clopine, Clozaril
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Clozapine

Clopine, Clozaril
😀
Supports positive mood
🏃
Supports motivation/interests
😌
Calming

Clozapine is very effective in treating psychosis for people who don't respond well to other antipsychotics. It is also the only antipsychotic proven to reduce the risk of self-harm. It tends to have more side effects than others including weight gain, sedation, constipation, too much saliva (spit) production and low white blood cells. Careful monitoring is needed including regular blood tests for the whole time a person takes clozapine.

Flip to show side effects

Flupenthixol

Fluanxol
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Flupenthixol

Fluanxol
🕗
Available as long action injection

Flupenthixol is an older antipsychotic, only available as a long acting injection (also known as a depot) in New Zealand. It was also used as a treatment for depression back in the 70’s and 80’s. Movement side effects and hormonal side effects are common with this medicine.

Flip to show side effects

Haloperidol

Serenace, Haldol
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Haloperidol

Serenace, Haldol
Less sedating, increased alertness
🕗
Available as long action injection

Haloperidol is an older antipsychotic that is sometimes used as a short term treatment when people are distressed or agitated in hospital. It can also be used over a longer period of time as tablets, liquid or a long acting injection. Common side effects include muscle stiffness and restlessness. It doesn’t help much with motivation, focus and attention, and might actually make these worse in some people if the dose is too high.

Flip to show side effects

Olanzapine

Zyprexa, Olanzapine-DRLA, Olanzine, Zypine
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Olanzapine

Zyprexa, Olanzapine-DRLA, Olanzine, Zypine
😀
Supports positive mood
🏃
Supports motivation/interests
😌
Calming

Olanzapine is often used for its calming effects when a person is distressed. It is available in tablets and a long acting injection. It seems to be slightly more effective than other antipsychotics (except clozapine). A lot of people find olanzapine makes them really hungry, which can lead to weight gain.

Flip to show side effects

Paliperidone

Invega, Invega Sustenna
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Paliperidone

Invega, Invega Sustenna
🏃
Supports motivation/interests
🕗
Available as long acting injection

Paliperidone is only available as a long acting monthly injection. It tends to cause less sleepiness than some of the other antipsychotics. However, movement and hormonal side effects are more common.

Flip to show side effects

Pericyazine

Neulactil
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Pericyazine

Neulactil
😌
Calming
😴
Helps with falling asleep

Pericyazine is an older medicine not used very much for psychosis anymore - other medicines are usually preferred. Like all older antipsychotics, it can cause movement and hormonal side effects. Weight gain and drowsiness are also quite common.

Flip to show side effects

Quetiapine

Quetapel, Auro-Quetiapine, DP-Quetiapine, Quetiapine-DRLA, Seroquel
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Quetiapine

Quetapel, Auro-Quetiapine, DP-Quetiapine, Quetiapine-DRLA, Seroquel
😀
Supports positive mood
🏃
Supports motivation/interests
😌
Calming

Quetiapine has some antidepressant effects, so might be good for people experiencing psychosis who also have a low mood or depression. It has a very low risk of movement and hormonal side effects, but often causes increased appetite and weight gain.

Flip to show side effects

Risperidone

Risperon, Risperdal, Risperidone (Actavis), Ridal, Risperdal, Risperidone (Arrow), Risperidone-DRLA
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Risperidone

Risperon, Risperdal, Risperidone (Actavis), Ridal, Risperdal, Risperidone (Arrow), Risperidone-DRLA
🏃
Supports motivation/interests
🕗
Available as long acting injection

Risperidone is available as tablets, liquid and a fortnightly long acting injection. It tends to cause less drowsiness than some other antipsychotics but movement and hormonal side effects are more common.

Flip to show side effects

Ziprasidone

Zusdone, Zeldox
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Ziprasidone

Zusdone, Zeldox
🏃
Supports motivation/interests
⚖️
Low risk of weight gain

Ziprasidone causes less weight gain, sedation and movement and hormonal side effects than some other antipsychotics. It may even increase alertness in some people, especially at lower doses. It is more likely to cause irregular heartbeat than many other antipsychotics so a doctor or nurse may check this at the start of treatment.

Flip to show side effects

Zuclopenthixol

Clopixol
Rare
Common
Drowsiness, lethargy
Is it unclear how many people experience this
Increased appetite, weight gain
Is it unclear how many people experience this
Issues with movement
Is it unclear how many people experience this
Restlessness
Is it unclear how many people experience this
Dry mouth, constipation, blurred vision
Is it unclear how many people experience this
Dizziness
Is it unclear how many people experience this
Hormonal side effects
Is it unclear how many people experience this
Flip to show summary

Zuclopenthixol

Clopixol
😌
Calming
😴
Helps with falling asleep
🕗
Available as long acting injection

Zuclopenthixol is an older antipsychotic, which is available as tablets and long acting injection. It tends to be sedating and calming and can help reduce aggression and agitation. As with the other older antipsychotics, movement and hormonal side effects are quite common.

Flip to show side effects
Medication information was compiled from the following sources:
Bazire S. Psychotropic Drug Directory 2016: The Professionals' Pocket Handbook and Aide Memoire: Lloyd-Reinhold Publications Limited; 2016.

Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry. 2016;50(5):410-72.

Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics : differential risk and clinical implications. CNS drugs. 2007;21(11):911-36.

Jibson MD. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. 2017 [last update May 15, 2017] In: UpToDate [Internet]. [cited 2 November 2017]. Available from: https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-and-side-effects

Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis.
Lancet (London, England). 2013;382(9896):951-62.

Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. The Lancet. 2012;379(9831):2063-71.

Marder S, Stroup T. Pharmacotherapy for schizophrenia: Side effect management. 2017 [last update Dec 01, 2016] In: UpToDate [Internet]. [cited 2 November 2017]. Available from: https://www.uptodate.com/contents/pharmacotherapy-for-schizophrenia-side-effect-management

New Zealand Formulary (NZF). NZF v[64] [Internet]. 2017. Available from: www.nzf.org.nz [accessed 02 November 2017].

Robinson DG, Gallego JA, John M, Petrides G, Hassoun Y, Zhang JP, et al. A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes. Schizophrenia bulletin. 2015;41(6):1227-36.

Stahl SM. Stahl's Essential Psychopharmacology : Neuroscientific Basis and Practical Application. 4th ed. Cambridge: Cambridge University Press 2013.

Stahl SM. Stahl's Essential Psychopharmacology: The Prescriber's Guide. 6th ed. Cambridge: Cambridge University Press 2017.

Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines in psychiatry. Twelfth edition. West Sussex, England : Wiley Blackwell. 2015.

Zhu Y, Li C, Huhn M, Rothe P, Krause M, Bighelli I, et al. How well do patients with a first episode of schizophrenia respond to antipsychotics: A systematic review and meta-analysis. European Neuropsychopharmacology. 2017;27(9):835-44.

Like any other medication, antipsychotics can cause side effects. While side effects may seem scary, they can be managed. Overall, the benefits of antipsychotics outweigh the downsides for most people.

Common side effects

Drowsiness, lethargy
What is it?

Feeling sleepy, lazy or lacking energy

What to do about it

Take the medication at night, develop a good routine for sleep and avoid napping during the day.  Try to increase physical activity during the day and get outside for some sunlight and fresh air. Drowsiness is more common when the dose is increased quickly. Reducing the dose and then increasing it more slowly can minimise this side effect. Drowsiness usually improves with time as people become ‘tolerant’ to the sedating effects. It’s important not to drive until drowsiness has resolved.

Antipsychotics can be used in higher doses when people are agitated or distressed. High doses can make some people feel quite sleepy or 'drugged up', which is why high doses should usually only be used for a short time until the person starts feeling better.

Increased appetite, weight gain
What is it?

Eating more and putting on weight

What to do about it

Weight gain seems to be related to increased appetite rather than directly slowing down metabolism. Weight gain can lead to health problems such as an increased risk of diabetes, heart attacks and strokes.

Stick to a healthy diet including lots of fruits and vegetables. Try to exercise regularly.  It can be difficult trying to fit exercise in but it can be as simple as doing more walking. Try to avoid fatty and sugary foods like chips, pies, lollies and chocolate. Drink plenty of fluid and keep sugary drinks like fizzy drinks and fruit juices to special occasions. Water is best and it’s free! Ask a member of your care team to see a dietician if you need help with food choices.

Movement side effects
What is it?
  • Feeling shaky, having a tremor or a ‘tick’ that people feel they can’t control
  • Slowed down movements
  • Stiff muscles
  • Sudden muscle cramps
  • A person’s neck may twist back
  • A person’s eyes and tongue may move on their own
What to do about it

These are not usually dangerous but if they are severe or worrying the person they should discuss it with their care team. Reducing the dose or changing to another antipsychotic can help. Medication is also available to treat this side effect, such as benztropine and procyclidine.

Restlessness
What is it?

Feeling uncomfortable and restless. Some people feel like they can’t keep still

What to do about it

This can improve with time but some people find it very unpleasant. If this is the case it should be discussed with the care team. Reducing the dose or changing to another antipsychotic can help. Medication can also be added to reduce the feeling of restlessness.

Dry Mouth
What is it?

A person’s mouth may feel dry and they may not produce much saliva (spit)

What to do about it

Drink plenty of water. Try carrying a drink bottle and having small sips often. Chewing sugarfree gum or sucking ice cubes in summer can help. Sprays, gels and mouthwashes for dry mouth are available from pharmacies. If nothing seems to help then a change in medication or dose might be needed.

Blurred vision
What is it?

Things look fuzzy or it is difficult to focus the eyes properly

What to do about it

This usually improves with time and doesn’t mean the person will need glasses. It should be discussed with the doctor or care team. It’s important not to drive until vision has gone back to normal.

Constipation
What is it?
  • Having difficulty passing a stool (poo), or going less often than usual
  • Feeling ‘bunged up’.
  • Sometimes there is loss of appetite, stomach pain, bloating or feeling sick.
  • Diarrhoea can also be a sign of constipation. If a hard mass of stool is blocking the bowel then small amounts of liquid stool may be passed.
What to do about it

Eat a high fibre diet including lots of fruits, vegetables and wholegrains. Drink at least 6-8 glasses of water a day. Doing more exercise such as walking can help to keep the bowels moving regularly.  If nothing seems to help or if the constipation is severe, then laxatives (medicines used to relieve and/or prevent constipation) may be needed. They can be bought from the pharmacy or supermarket, but it is often better to go through your doctor as they are cheaper on a prescription.

For people taking the antipsychotic clozapine, constipation can be serious and needs to be treated quickly. People taking clozapine should have a plan for managing constipation agreed in advance. If constipation has gone on longer than 2 days they should contact their care team urgently.

Dizziness, lightheadedness
What is it?

Feeling dizzy, woozy, faint, or like the room is spinning

What to do about it

Dizziness is more common when starting a medicine or after a dose increase and can improve with time. Increasing the dose more slowly can minimise this side effect. It’s important not to drive until dizziness has resolved. A change in medication or dose might be needed if dizziness is severe or doesn’t seem to be getting better.

Hormonal side effects
What are they?

Side effects that are caused by high prolactin levels. Prolactin is a hormone that is normally present in the body in both men and women but at a lower level. Prolactin levels increase during pregnancy and breastfeeding in women because this helps with breast milk production. Antipsychotics can increase prolactin above the usual level when it is not needed. 

The number and type of side effects a person gets from having high prolactin levels depends on a number of things. These include how high the prolactin level is, whether they are male or female and how sensitive the individual person is to having high prolactin. Common side effects can happen when prolactin is only slightly higher than the usual range. Less common and rare side effects usually only happen when the prolactin is much higher than the usual range.

Common

Sexual dysfunction - this can include losing interest in sex (low libido), difficulty getting or maintaining erection for men or difficulty having an orgasm

Less common

Changes in the menstrual cycle for women - periods can become irregular or stop altogether

Increased growth of body hair in women (hirsutism)

Swollen breast tissue, breast tenderness or breast growth - This can happen to both men and women

Rare

Milk production - people may notice milk coming out of their breasts (this can happen to both men and women)

What to do about it

These side effects can seem concerning but they are fully reversible and will go away with a change in treatment. People who have any of the side effects associated with high prolactin levels should talk to their care team – they can do a simple blood test to check the prolactin level. Medication may need to be changed or the dose reduced. Sometimes another medicine can be added to manage this side effect.

High cholesterol or blood sugar
What is it?

Cholesterol and triglycerides are types of fat (lipid) in the blood. High blood sugar is also known as increased blood glucose. These will show up in blood test results. Over time, these side effects can put people at an increased risk of developing heart disease and diabetes.

What to do about it

Preventing these side effects with a healthy lifestyle is the best way to manage them. This includes eating a healthy diet and exercising regularly.

It is also important to see the care team or family doctor (GP) for a physical health check-up. They will monitor any changes in a person’s weight, blood pressure, cholesterol and blood sugar. This should happen at least once per year but might be more often after starting or changing medication, or when blood results show high cholesterol or blood sugar.

Rare side effects

Palpitations
What is it?

A fast or irregular heartbeat 

What to do about it

Contact the doctor or care team. This is not usually dangerous but the team might want to look into it further.

Skin rashes
What is it?

Blotches or marks seen anywhere on the skin 

What to do about it

Contact your doctor immediately

Urinary retention
What is it?

Difficulty in passing urine (peeing) or not much urine passed

What to do about it

Contact the doctor immediately

NMS (Neuroleptic Malignant Syndrome)
What is it?

Signs and symptoms of NMS include confusion, a high body temperature (fever), sweating, very stiff or rigid muscles, and a fast heartbeat. The risk of NMS is increased in some situations such as taking high doses of antipsychotics, more than one antipsychotic or after a big dose increase. Having certain medical conditions can also increase the risk.

What to do about it

Contact a doctor immediately. A doctor will be able to tell whether the symptoms are likely to be NMS. An admission to hospital might be needed until the person recovers.

Medication information on this page was compiled from the following sources:
Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics : differential risk and clinical implications. CNS drugs. 2007;21(11):911-36.
New Zealand Formulary (NZF). NZF v[64] [Internet]. 2017. Available from: www.nzf.org.nz [accessed 02 November 2017].
Robinson DG, Gallego JA, John M, Petrides G, Hassoun Y, Zhang JP, et al. A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes. Schizophrenia bulletin. 2015;41(6):1227-36.
Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines in psychiatry. Twelfth edition. ed: West Sussex, England : Wiley Blackwell. 2015.
Bazire S. Psychotropic Drug Directory 2016: The Professionals' Pocket Handbook and Aide Memoire: Lloyd-Reinhold Publications Limited; 2016.
Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet (London, England). 2013;382(9896):951-62.
Jibson MD. Up to date. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-and-side-effect
Jibson MD. Second-generation antipsychotic medications: pharmacology, administration, and side effects. Marder S, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com [accessed 02 November 2017]
Marder S, Stroup TS. Pharmacotherapy for schizophrenia: Side effect management. Stein MB, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com [accessed 02 November 2017]
Stahl SM. Stahl's Essential Psychopharmacology : Neuroscientific Basis and Practical Application. 4th ed. Cambridge: Cambridge University Press 2013.
Stahl SM. Stahl's Essential Psychopharmacology: The Prescriber's Guide. 6th ed. Cambridge: Cambridge University Press 2017

Psychosis and culture

Explanations for symptoms of health and illness in some cultures could be quite different from Western beliefs. For example, because Māori often report seeing deceased relatives and hearing them speak, they may sometimes be diagnosed as having psychosis. However, from a Māori perspective, a person having visions or hearing voices is often considered to have a special link to their ancestors, therefore these may not be enough of a reason to determine if someone is experiencing psychosis. To learn about experiences of psychosis from a Māori perspective, read this resource or watch this short video.

Psychosis and culture

Explanations for symptoms of health and illness in some cultures could be quite different from Western beliefs. For example, because Māori often report seeing deceased relatives and hearing them speak, they may sometimes be diagnosed as having psychosis. However, from a Māori perspective, a person having visions or hearing voices is often considered to have a special link to their ancestors, therefore these may not be enough of a reason to determine if someone is experiencing psychosis. To learn about experiences of psychosis from a Māori perspective, read this resource or watch this short video.

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Why it happens

Why it happens