What medication would probably be ordered for the acutely aggressive schizophrenic client?
A. chlorpromazine (Thorazine)
B. haloperidol (Haldol)
C. lithium carbonate (Lithonate)
D. amitriptyline (Elavil)
Correct Answer: B. haloperidol (Haldol)
Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. 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. It is a typical antipsychotic because it works on positive symptoms of schizophrenia, such as hallucinations and delusions.
Option A: Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Chlorpromazine belongs to the category of typical antipsychotics or neuroleptics, also known as first-generation antipsychotics (FGAs). It produces its antipsychotic effect by the post-synaptic blockade at the D2 receptors in the mesolimbic pathway. However, the blockade of D2 receptors in the nigrostriatal pathway is responsible for its extrapyramidal side effects.
Option C: Lithium was the first mood stabilizer and is still the first-line treatment option, but is underutilized because it is an older drug. Lithium is a commonly prescribed drug for a manic episode in bipolar disorder as well as maintenance therapy of bipolar disorder in a patient with a history of a manic episode. The primary target symptoms of lithium are mania and unstable mood.
Option D: Amitriptyline is used for depression. Amitriptyline is in the tricyclic antidepressant (TCA) drug classification and acts by blocking the reuptake of both serotonin and norepinephrine neurotransmitters. The three-ring central structure, along with a side chain, is the basic structure of tricyclic antidepressants. Amitriptyline is a tertiary amine and has strong binding affinities for alpha-adrenergic, histamine (H1), and muscarinic (M1) receptors. It is more sedating and has increased anticholinergic properties compared to other TCAs.