St. Luke’s College of Medicine – William H.

Quasha Memorial
PSYCHIATRY II
Lecture: Treatment and Management of Psychotic Disorders Date: August 25, 2017
Blk 1 – Lec 4 Lecturer: Christine DN Lagman, MD, DPBP, FPPA, IFAPA Trans Team: Pineda & Pua

Topic Outline  Diagnosis

I. Overview III. Psychotherapy
II. Hospitalisation A. Supportive
A. Goals B. Group
B. Indications C. Psychosocial
C. Short-Term Hospice D. Psychoeducation
D. Long-Term Hospice E. Support Group
E. Basic Screening Tests IV. Pharmacotherapy
F. Side Effects A. Typical Neuroleptics
G. Current trends B. Atypical Neuroleptics
V. Other Biological Therapies
VI. Quiz
PPT Audio Book Transers Subhead
I. OVERVIEW
 Treatment programs for persons with Schizophrenia (and
psychotic disorders) must be individualized
comprehensive
• taking into consideration the biologic, psychological, and
social needs of each patient
• Depending on the patient’s condition whatever your
diagnosis is, depending on the severity, depending on the
stressors, and depending on the financial status of the
patient
 Attention must be paid to the continuity of care.
• When we say continuity of care, it has to be depending on
the needs of the patient. Kahit schizophrenia yung diagnosis
of five patients, depending on the severity and psychosocial
issues nila, you have to spend an hour with them to address
their problems
 Care setting should be as nonrestrictive as possible, and every
attempt should be made to reintegrate patients into the
community
• meaning as much as possible they should stay at home with
their families.
• every activity should be made to re-integrate patients into
the community.
• e.g. after hospitalisation, bed rest at home first, then after a
month or two we should encourage them to go back to
whatever work is possible for them even if it’s just
housework. But they have to do something. When we say
reintegrate into the community, for example going to the
market, buying groceries, driving for their families or kids.
 Modern treatment methods make it possible for about 90% of
schizophrenic patients to recover sufficiently outside the
hospital most of the time
 Some studies suggest that about 75% of individuals who meet
the diagnostic criteria for schizophrenia experience substantial
or complete recovery 20-25 years (or longer) after the onset of
the illness
 Complete recovery means they can still take care of
themselves, some of them can keep jobs but they do still have
slow decline so they have to still be continuously treated.
II. HOSPITALIZATION
A. GOALS
 Protection:
• Safe environment where physical needs can be met,
stresses can be minimized, impulses can be controlled (for
patients with stressful home situations, or are violent and
agitated)
• E.g. physical needs: current patient who is now hospitalised,
physical means need to be met [by someone else] because
she doesn’t eat, she doesn’t take a bath everyday, she
hardly goes out of her room, she doesn’t exactly use the
bathroom she just relieves herself wherever.
• E.g. stresses: this patient has a very dysfunctional family.
Yes, they are rich but because they are rich her other
siblings are interested in her inheritance so they’re using her
money for themselves. And the patient knows this so she
gets more stress.
• E.g. impulses: this patient has access to wifi. So she gets to
use Facebook and because she’s 56 y/o, she’s female, she’s
single, she has met many boyfriends through the internet,
specifically through Facebook. And these boyfriends from
other countries will ask money from her so nagpapadala siya
for example 175 k today, then 2400 for boyfriend B. So her
siblings are also arguing with her.
• 24-hour care allows for extensive observation and evaluation
of a patient’s problems, strengths, history, support, and
response to treatment
• This is specific for first time patients, those who are newly
diagnosed, so that you can get all the information you need,
so you know all the psychosocial stressors they have, and
do all the labs and ancillary procedures the patient needs
• access to diagnostic laboratory and neuroradiologic tests
• e.g. start the patient on a certain medication and suddenly
the patient experiences hypotention, a possible side effect of
the medication, immediate care for the patient can be
provided unlike at home where the relatives will panic and
and just bring the patient to the ER—hopefully. Some don’t.
 Therapy
• Neuroleptic medication (note the effects and side effects)
• When we talk about hospitalisation with patients with
schizophrenia, it doesn’t take just one week or two weeks.
Most of the time, it takes a month. During that
hospitalisation, acute care is given, medications are given,
and at the same time psychotherapy is initiated after a week
or so once the medication kicks in.
• Vocational and psychosocial rehabilitation

• Family education. You have to explain to the family what
your treatment plan and your diagnosis is. You have to
explain the chemical imbalances, you have to explain the
effects and side effects of medication and the need for
continuity of care after discharge.
B. INDICATIONS
 First episodes of psychosis and unusual presentations of
psychotic conditions
 Sudden and acute appearance of psychotic symptoms should
give you a heads up that the patient has to be hospitalised
 Presence of specific problems associated with a person’s
illness rather than because of the appearance of symptoms
 Lack of appropriate community mental health resources
 Provision of rehabilitative services before discharge to
community programs
 Care for a severely debilitated schizophrenic patient
 Treatment of significant comorbidity from medical illnesses,
substance abuse, medication complications
 Protection from self-inflicted harm or danger to others
C. PROBLEMS REQUIRING SHORT-TERM HOSPITAL CARE
 Risk of suicidal and homicidal ideation
• If you hospitalise a patient for just a week or two weeks
without the resolution of symptoms, or the symptoms aren’t
well managed by the patient, once you discharge them,
there’s a risk for suicide and homicidal ideation
• E.g. Patient was suicidal, diagnosed with schizophrenia, has
high IQ, Caucasian, lives on the 3rd floor. Attempted suicide
thrice. First time, he tried to hang himself, but was stopped
by his kasmbahay. Second time, he took muriatic acid, and
he was also caught so he was rushed to the hospital.
Referred to GI. Third time, he slashed his neck, brought to
the ER and referred to ENT. O.o The problem was, patient
was never referred to psychiatry. The fourth time he was
going to attempt to jump from the building, he was caught
again and then he was referred to psychiatry. On the fifth or
sixth hospital day, the patient removed his ID and jumped off
the building. (persistent ah) Because it’s just the third floor,
he didn’t die but sustained several broken ribs. In the ICU,
the patient was coherent but he was really sorry and he
began to realise that God is giving him so many chances at
life so he decided not to commit suicide anymore. Problem
was he developed nosocomial pneumonia and eventually
died #truestory
 Command hallucinations of a threatening nature, with the
clinician’s assessment that the patient may act on these
hallucinations
 Extreme fear
 Significant confusion

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• if he’s not oriented with time or place or person. Evaluate
that in the morning and at night because MSE always differs
several times in a day.
D. PROBLEMS REQUIRING LONG-TERM HOSPITAL CARE
 In our country, there is a lack of community health resources.
 Provision of rehabilitation services before discharge into
community programs. Most of the psychiatric facilities don’t
offer rehabilitation.
 Care for severely debilitated schizophrenic patients. There are
very few nurses who subspecialties in psychiatric care. Most of
them are in the USA.
 Treatment of significant co-morbidity from medical illness,
substance abuse and medication complications. Sometimes
we forget that the patient has other medical conditions. We
tend to concentrate on the psychotic symptoms alone.
 Protection from self-inflicted harm or danger to others.
 When there is long term hospital care, they realise that when
you visit them, you’re evaluating them. So they’ll give you and
answer that you want to hear. Dr: Do you still ear whispering?
Px: No, Doc :] Wala nang gumugulo sa isip ko. So you have to
be careful. You have to observe them. Patients who mumble.
Ask the watcher if the patient is whispering. It means they still
experience auditory hallucinations because he or she is talking
to the voice. They tell you what you want to hear, then once
they are discharged, they go on and attempt suicide. So, look
for inconsistencies.
E. BASIC SCREENING TESTS
 Screening for concurrent disease, ruling out organicity, and
establishing baseline values of functions to be monitored
• Complete blood count (CBC)
• Kidney function tests (BUN, creatinine)
• Liver function tests (SGPT, SGOT)
• Thyroid function tests (T3, FT4, TSH)
• Electrolytes, Blood sugar
• Methamphetamine and Cannabinoid Assay
• Pregnancy Test (neuroleptics are counter-indicated in
pregnant patients especially in the first trimester.)
• Urinalysis (Some patients who experience UTI manifest with
psychosis. Treat the UTI, and the psychosis will disappear.
So no need for neuroleptics.)
• Spinal Tap, EEG, CT scan/MRI (psychosis may be
secondary to a neurological condition)
 Hospitalization is not necessarily indicated for an exacerbation
of psychotic symptoms if adequate community alternatives are
available
F. SIDE EFFECTS
 Possible loss of self-esteem and social stigmatization as a
result of being on a “mental ward”
• We don’t have a mental ward in St. Luke’s but in other
hospitals when a patient is admitted in the mental ward, all of
the differently diagnosed patients are lumped together. So,
they have a difficult time adjusting.
• Just imagine if you’re psychotic and you’re with these
strangers, won’t you feel more paranoid? Then people in
white will give you pills to take every night or every morning
and then the pills will make you sleepy and you don’t know
what will happen to you. So it’s scary. We have to consider
that.
 Possible loss of social supports in the community
• E.g. once the patient applies for a job and they declare that
they have a mental condition, they will not be accepted. It’s
difficult to find employment even if its simply anxiety or
depression. For most people, as long as you have a mental
condition, you’re crazy.
 Loss of social and living skills required to live in the world
outside the hospital with prolonged hospitalization
• Some patients in psychiatric facilities actually prefer to stay
because food is available, you have a place to sleep, there
are nurses who take care of you unlike at home where no
one talks to you, you don’t feel like there’s stigma because
everyone is a psychiatric patient, so they prefer to stay in the
facility with prolonged hospitalisation
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G. CURRENTS TRENDS
 Halfway houses HTD
• Houses in the community where physicians, nurses, and
others provide acute stabilization of psychotic symptoms and
rapid reintegration into the community
• Available all over the Philippines
• When I say houses they’re really houses like PBB. They
don’t feel like they’re in the hospital. When they’re in the
hospital they don’t really do anything. In the halfway houses,
they’re allowed to do sports, go on field trips, go to the gym.
These are the expensive halfway houses. The cheaper ones
are simpler. They just offer board and lodging for the patient.
 Therapeutic milieu
• Hospital setting with rehabilitation programs and
psychoeducational activities
• Although NCMH is trying to provide one, we still don’t have
one in the Philippines
 Day care centers
• Community setting with vocational programs and
psychoeducational activities
• We have these in the Philippine Mental Health association,
there is a work centre there where patients can go everyday
and at the end of the day they can go home
III. PSYCHOTHERAPY
 Different from psychoanalysis
A. SUPPORTIVE PSYCHOTHERAPY
 Promotes patients’ self-esteem and helps them learn about
their real strengths and limitations
 Focuses on practical and concrete issues
 Analysis of symptoms is not done in this sort of psychotherapy.
 This is the most common kind of psychotherapy
B. GROUP PSYCHOTHERAPY
 Focused on communication, alleviation of symptoms, and
social skills produces improvements in social reintegration
 Focused discussion
 Available in the Philippine Mental Health Association and the
Medical City.
 Patients have the same condition, and is facilitated by a
psychiatrist
 If they become friends and meet outside the group, we have no
control over that. #ohnodangerous
 An example of this is AA (Alcohols anonymous)
C. PSYCHOSOCIAL PSYCHOTHERAPY
 Addresses living skills acquisition, housing, managing
finances, managing the illness, recreational activities
 Sometimes patients don’t know what to do anymore. All they
know is they have to take medication, they rest, they watch TV,
eat, rest, take medicine, repeat. We have to reintegrate them
and teach them how to manage themselves.
D. PSYCHOEDUCATION
 Include the relatives no matter how toxic the relatives are.
Honestly the patients are easy to handle. It’s the relatives who
are a problem.
 Nature and course of disease
 Recognizing signs of relapse, medication side effects
 Working with persistent symptoms
 For example, auditory hallucinations never completely
disappear especially in patients with schizophrenia so every
once in a while there are still voices but patients with the help
of medication learn how to cope with the voices.
 That’s specifically called salience (I will not ask that in the
exam but it’s very important that you know)
E. SUPPORT GROUPS
 For patients and relatives
 This is different from group therapy, enhanced social skills and
become friends and relatives know how to manage and cope
because they talk.
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 They also have the tendency to compare their management Table 3. Adverse Effects of Typical Neuroleptics
and coping so it’s important that a psychiatrist is present to EXTRAPYRAMIDAL • Result from blockade of dopamine
monitor what’s happening and to correct any practices. SYNDROMES receptors in the basal ganglia;
occur more commonly with the
IV. PHARMACOTHERAPY Alternatives: high-potency neuroleptics
 50/50 management of psychiatric patients: 50% Clozapine • As a rule, once the patient
psychotherapy and 50% pharmacotherapy Bisperiden manifests with EPS, it means the
Diphenhydramine medication is taking effect. 60% of
dopamine receptors are being
A. ANTIPSYCHOTICS
blocked. However, EPS is very
Table 1. Difference Between Typical and Atypical Antipsychotics uncomfortable for the patient.
Typical Agents Atypical Agents Acute dystonia • More common in young males;
• Dopamine Receptor • Serotonin-Dopamine occurs immediately after intake of
Antagonists/First Antagonists/Second neuroleptic; involve sudden tonic
Generation Antipsychotics Generation Antipsychotics Acute dystonia: young males contractions of the muscles of the
• traditional antipsychotics; • novel antipsychotics; Akathisia: middle age females tongue, neck, back, mouth, and
effective in positive balanced efficacy; fewer Parkinsonism: elderly eyes
symptoms; associated with side effects • It can look like stroke. Hands and
a number of side effects • Expensive (P300 for one neck are rigid.
• Cheap (P75 and below) pill) • Medication: give diphenhydramine
IM or IV and it will resolve in a few
Typical Neuroleptics minutes
 Chlorpromazine was developed in 1948 Parkinsonism • Most common
 Most were developed during the 1960s • More common in elderly patients;
 Exert primary effects by blocking dopamine receptors, D2 occurs in the first weeks of
 Incompletely absorbed after oral administration treatment; characterized by
 Peak plasma concentration in 1-4 hours cogwheel rigidity, bradykinesia,
 T1/2 from 10-20 hours tremor, loss of postural reflexes,
 Given once or twice a day mask-like facies, drooling
 High protein binding, volume of distribution, lipid solubilities Akathisia • More common in middle-aged
 Metabolized in the liver with steady state in 5-10 days women; a syndrome of motor
 If the patient has a liver problem or presents with jaundice, restlessness, inability to keep legs
please refrain from giving typical neuroleptics and shift to and feet still
atypical neuroleptics • Restless patients. They feel very
 Those in red are available in the Philippines uncomfortable if they aren’t moving.
Tardive dyskinesia • Late-onset movement disorder
Table 2. Classes of Typical Neuroleptics which results from a disturbance in
CLASSES OF TYPICAL NEUROLEPTICS dopamine acetylcholine balance in
PTBB Phenothiazines ALIPHATICS Chlorpromazine the basal ganglia; occurs in chronic
APP Levomepromazine patients; includes fasciculations of
PIPERAZINE Trifluoperazine the tongue, choreoathetotic
Fluphenazine movements of the extremities and
Perphenazine trunk. Patients cannot stop the
PIPERIDINE Thioridazine movements.
Thioxanthenes Flupenthixol (hard to find) • More common in patients taking
Zuclopenthixol typical neuroleptics.
Butyrophenone Haloperidol (Violent ER patients, IM shot but • Either stop medication or shift
can also be taken orally) medication to clozapine (will be
Atypical
Benzamide Amisulpride (predominantly works on asked in the exam)
antipsychotic
dopamine but it also works on the serotonin. NEUROLEPTIC • A potentially life-threatening drug
At low doses, can be used for depression or MALIGNANT complication of neuroleptic therapy
anxiety) SYNDROME whether typical or atypical
Those available in the Philippines are in red. According to the 2018 • Characterized by rapid onset of
trans, this table is worth 5 points muscular rigidity, high fever,
autonomic instability, and altered
ROUTE OF ADMINISTRATION level of consciousness
 Oral forms (available in pill, capsule, elixir preparation) • Treatment involves immediate
• Chlorpromazine and Levomepromazine discontinuation of the neuroleptic
• Elixir preparation is no longer available in the market medication and support of
 Parenteral forms (IM, IV; necessary for patients who are too respiratory, renal, and
agitated or incapacitated to comply with treatment) cardiovascular functioning, and
possibly treatment with dantrolene
• Do not give IV. Be careful in giving IV especially with first
or bromocriptine (either one is fine)
time patients. They may suffer from neuroleptic
malignancy syndrome. • Patient may die if this is not
recognized immediately
 Long-acting injections (depot formulations; effective for 2-4
weeks; patients who prefer not to have to take medication on a CARDIOVASCULAR • Includes orthostatic hypotension,
daily basis, noncompliant patients) EFFECTS ventricular arrhythmias, T-wave
• Typical depot antipsychotics are given every 4 weeks, 100 changes, prolonged QT intervals
PHP. Atypical ones are given every 2 weeks, 12,000 PHP. • Associated with low potency
Difference is the price. neuroleptics
• 1 Fluphenazine injection is good for 1 month • Start low, go slow in elderly or
• Flupenthixol is also a depot medication patients with heart conditions. This
may result in MI.
HYPOTHALAMIC • Decreased libido, increased
EFFECTS appetite, change in temperature
regulation,

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• Hypersecretion of prolactin
(amenorrhea, breast enlargement,
galactorrhea) even in males so it
can be very disturbing for males
• Please, small breasted ladies
• Risperidone and amisulpride These are atypical
JAUNDICE • Elevation of liver enzymes
• Yellowish discoloration (skin, eyes,
lips)
AGRANULOCYTOSIS • Commonly associated with
clozapine. More common in
Caucasians.
• Spontaneous bruises, infections
that do not resolve, cuts that do not
heal
DERMATOLOGIC • Allergic rashes
EFFECTS • Photosensitivity
OPTHALMOLOGIC • Pigmentary retinopathy
EFFECTS • Lens and corneal pigmentation
Atypical Neuroleptics
• Developed in the early 90s
• Couple their D2 antagonism with 5HT2A antagonism
(serotonin)
• The dissociation rate at the D2 receptor sets apart the
atypicality of an anti-psychotic
• Atypical antipsychotics can also be D2 partial agonists
(specifically aripirazole)
Table 4. Classes of Atypical Neuroleptics.
CLASSES OF ATYPICAL NEUROLEPTICS
Dibenzodiazepine Clozapine
• Works fast for both positive
and negative effects
6 • Receptor sites: D1, D2, D3,
D4, 5HT2a, alpha1
• Peak plasma: 2 hours
• Half-life: 12 hours (ideally,
patient is awake for another 12
Bbtda hours)
Croqa • Indication: For treatment-
resistant schizophrenia but
now can be used for fist line
treatment, severe tardive Remember earlier
dyskinesia, for patients with
decreased EPS threshold
• Causes agranulocytosis
Benzisoxazole Risperidone
5 • Receptor sites: D2, 5HT2a,
alpha1, alpha2, H1
• Undergoes extensive first-pass
effect
• Peak plasma: 1 hour
• Half-life: 20 hours
• Bioactivity: 70%
• Indication: First line treatment
for schizophrenia, aggression,
psychotic depression, acute Sapa
mania
• Hypersecretion of prolactin.
Monitor levels and refer to
endocrinology or discontinue
use if side effects develop
• If the patient is responding well
but there is hypersecretion of
prolactin, refer
• Adverse Effects: amenorrhea, Hypothalamic effects
galactorrhea, breast enlargement
Paliperidone
Thienobenzodiazepine Olanzapine
11• Receptor sites: D1, D2, D4,
5HT1a, 5HT2a, H1, M1, M2,
M3, M4, M5
• Undergoes first-pass effect
• Peak plasma: 5 hours
• Half-life: 31 hours
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Sapa
• Bioactivity: 85%
• Indication: First line treatment
for schizophrenia, aggression,
Same with Risperidone psychotic depression, acute
mania
• Adverse effects: Metabolic
side effects + weight gain
(obesity)
• Most patients complain of
lethargy
• Very good for drug users
• Again, if the patient is
responding well but has side
effects, refer to endocrinology.
Dibenzothiazepine Quetiapine
7 • Receptor sites: D1, D2, 5HT2,
5HT6, alpha1, alpha2, H1
• Peak plasma: 1-2 hours
• Half-life: 7 hours (sometimes
dose has to be increased)
• Quetiapine XR half-life: 12-
16 hours (works after 3 hours
so patient has to take it 3
hours before. Plain Quetiapine
works after 20 minutes)
• Indication: First line treatment
for schizophrenia, acute
mania, bipolar depression,
aggression, psychotic
depression, severe anxiety
• If you don’t know the diagnosis
of the patient, give this drug
and they get better! But don’t
do this. You have to know the
diagnosis! (magic pill)
• Low doses: can be used for
anxiety, depression
• High doses: can be used for
psychotic disorders (i.e.
schizophrenia, bipolar disorder)
• Very high doses: works on
bipolar
• Can cause QT prolongation so
might cause MI
• Also causes weight gain and
lethargy
Asenapine
• Used to be available in the
Philippines and was well
tolerated but was pulled out
last year
Arylpiperidylindole Arpiprazole
• The safest of them all. Minimal
side effects and low drug-drug
interactions
3 • Receptor sites: Partial D2
agonist, 5HT2a, alpha1
• Peak plasma: 3-5 hours
• Half-life: 75 hours (can give
after three days, but should
still be given every day)
• Approved as adjunct or
monotherapy for depression
• Indication: First line treatment
for schizophrenia, acute
mania, aggression, psychotic
depression
Sapa
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 PSYCHIATRY II| Lec 4 | Tx & Management of Psychotic Disorders | V. 1
Please study this chart and take note of the side effects of each!  Transcranial magnetic stimulation
• Stimulation of local electrical currents in the brain via a
Table 5. Adverse Effects of Selected Antipsychotics. magnetic field; currently approved as adjunctive treatment
for treatment-resistant schizophrenia
• Available locally
• Patient has to be maintained on oral antipsychotics
 Psychosurgery
• Surgical intervention to sever fibers connecting one part of
the brain with another
EPS - + - - + • No longer practiced
Tardive - + - - - VI. Quiz
dyskinesia Risperidone
1. Which typical neuroleptic is notorious for prolactin increase?
Seizure +++ - + - - 2. Patient stays in a hospital with other patients. He is able to
learn how to cook. What form of management is this?
Sedation, +++ + + + - a. Hospitalization c. Therapeutic milleu
somnolence b. Halfway House d. Day Care center
3. Elderly patient with hypertension and a heart murmur is found
NMS + + + - - to have a QT prolongation on ECG. What drug is he likely to
be taking and what do you do? Quetiapine
Orthostatic +++ + + - - 4. Psychotherapy that involves other patients with the same
hypotension illness
QTc prolongation - + - + - a. Psychoeducation c. Group therapy
b. Supportive psychotherapy d. Support group
Liver + + + + - 5. Two drugs that can be used in managing EPS? Bisperiden
transaminase Diphenydramine
increase Answers:
1. Benzisoxazole.
Anticholinergic +++ - + - - 2. C.
adverse effects 3. Quetiapine. Switch the drug!!
4. C.
Agranulocytosis +++ - - - - 5. Bisperiden and Diphenhydramine.
Prolactin increase - +++ - - - AE Summary

Weight gain +++ + +++ + - Aripriprazole: EPS (only AE)

Nasal congestion + + + + - Tardive dyskinesia: Risperidone
Prolactin increase: Risperidone
Antiparksonian Medications Agranulocytosis: Clozapine
 For management of EPS
 Bisperiden EPS: Risperidone and Aripiprazole
 Diphenhydramine Seizure: Clozapine and Olanzapine
 Anticholinergic side effects (at low doses) QTc prolongation: Risperidone and Quetiapine
• Blurred vision, urinary retention, constipation Anticholinergic effects: Risperidone and Olanzapine
• Side effects will decrease when dose is lowered
NMS and Orthostatic hypotension
 Anticholinergic poisoning (at high doses)
Risperidone, Clozapine, Olanzapine
• Restless agitation, confusion, disorientation, hallucinations,
delusions, hot flushes, dry skin, pupil dilation, tachycardia,
Sedation, somnolence
decreased bowel sounds, urinary retention Liver transaminase imcrease
 Anticholinergic abuse Weight hain
• Altered consciousness Nasal comgestion
• They feel high and they like it Tpa esqa no

V. Other Biologic Therapies EVTP

 ECT (Electroconvulsive Therapy)
• The APA recommends reserving this for patients with severe
psychotic symptoms, suicidal/homicidal patients
• This is still being done at NCMH
• In other hospitals there are anesthesiologists so patients
don’t feel any pain
• American psychiatric association recommends this for
patients with severe psychotic symptoms and
suicidal/homicidal patients
• This is also safe for children and adolescents, even for
pregnant women. Also for the elderly.
• If the antipsychotics take effect in 2 weeks, with ECT, you
see marked improvement after 2 sessions
• Side effect: temporary amnesia right after the procedure but
it comes back after a few hours
 Vagus nerve stimulation
• Electrical stimulation of the left vagus nerve; currently
approved as adjunctive treatment for treatment-resistant
schizophrenia
• Not available here in the Philippines but will be asked in
exam

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Appendix
Table 6. Summary Table of Antipsychotics (Lifted from Batch 2018 Trans).

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