Antipsychotic Poisoning

A medical emergency caused by toxic levels of antipsychotic medications in the body

What is Antipsychotic Poisoning?

Antipsychotic poisoning, also known as antipsychotic overdose or toxicity, occurs when there are dangerously high levels of antipsychotic medications in the body. This can happen through accidental overdose, intentional overdose, drug interactions, or impaired metabolism. Antipsychotic medications are used to treat conditions like schizophrenia, bipolar disorder, and other psychiatric conditions, but when taken in excessive amounts, they can cause serious and potentially life-threatening complications.

Common Symptoms

Antipsychotic poisoning can cause various neurological and physical symptoms:

Additional Symptoms of Antipsychotic Toxicity

Antipsychotic poisoning can cause a wide range of symptoms affecting multiple body systems:

Neurological Symptoms

  • Altered consciousness or confusion
  • Seizures
  • Coma
  • Extrapyramidal symptoms (muscle rigidity, tremors)
  • Tardive dyskinesia (involuntary movements)
  • Neuroleptic malignant syndrome

Cardiovascular Symptoms

  • Irregular heartbeat (arrhythmias)
  • Low blood pressure (hypotension)
  • QT prolongation on ECG
  • Torsades de pointes (dangerous heart rhythm)

Other Symptoms

  • Difficulty breathing
  • Extreme drowsiness
  • Temperature regulation problems
  • Nausea and vomiting
  • Dry mouth
  • Blurred vision

Common Causes

Antipsychotic poisoning can occur through various mechanisms:

Accidental Overdose

  • Medication errors: Taking wrong dose or double-dosing
  • Confusion: Memory problems leading to extra doses
  • Child access: Children accidentally ingesting medications
  • Prescription errors: Incorrect dosing by healthcare providers

Intentional Overdose

  • Suicide attempts: Deliberate overdose for self-harm
  • Recreational abuse: Misuse for sedating effects
  • Self-medication: Taking extra doses during crisis

Drug Interactions and Medical Factors

  • CYP enzyme inhibitors: Drugs that slow antipsychotic metabolism
  • Liver disease: Impaired drug clearance
  • Kidney disease: Reduced drug elimination
  • Age factors: Elderly patients with slower metabolism
  • Genetic factors: Poor metabolizers of certain drugs

Types of Antipsychotic Medications

Typical (First-Generation)

Haloperidol, chlorpromazine, fluphenazine. Higher risk of extrapyramidal side effects and movement disorders.

Atypical (Second-Generation)

Risperidone, olanzapine, quetiapine, aripiprazole. Lower risk of movement disorders but higher metabolic risks.

Emergency Recognition

Antipsychotic poisoning is a medical emergency. Critical signs include:

⚠️ Immediate Emergency Signs

  • Loss of consciousness or unresponsiveness
  • Severe difficulty breathing
  • Seizures
  • Irregular or very slow heartbeat
  • Extremely low blood pressure
  • High fever with muscle rigidity
  • Severe involuntary muscle movements

Treatment Options

Emergency Treatment

  • Airway management: Ensure adequate breathing and oxygenation
  • Cardiac monitoring: Continuous ECG monitoring for arrhythmias
  • IV fluids: Support blood pressure and circulation
  • Activated charcoal: If ingestion was recent (within 1-2 hours)
  • Gastric lavage: Rarely used, only if very recent ingestion

Supportive Care

  • Blood pressure support: Vasopressors if needed
  • Seizure control: Anticonvulsants if seizures occur
  • Temperature control: Cooling measures for hyperthermia
  • Electrolyte monitoring: Correct imbalances
  • Fluid balance: Prevent dehydration or overload

Specific Antidotes and Treatments

  • Physostigmine: For severe anticholinergic effects
  • Sodium bicarbonate: For cardiac conduction abnormalities
  • Magnesium: For torsades de pointes
  • Benzodiazepines: For agitation and seizures
  • Dantrolene: For neuroleptic malignant syndrome

When to Call 911

Call emergency services immediately if someone has:

  • Taken more antipsychotic medication than prescribed
  • Lost consciousness or is extremely drowsy
  • Difficulty breathing or turning blue
  • Seizures or convulsions
  • Severe confusion or altered mental state
  • Chest pain or irregular heartbeat
  • High fever with muscle stiffness
  • Uncontrollable muscle movements

Poison Control

Also contact Poison Control at 1-800-222-1222 for guidance while waiting for emergency services.

Potential Complications

  • Neuroleptic malignant syndrome: Life-threatening reaction with fever, rigidity
  • Cardiac arrhythmias: Dangerous heart rhythm disturbances
  • Respiratory depression: Slowed or stopped breathing
  • Coma: Prolonged loss of consciousness
  • Permanent neurological damage: Brain injury from hypoxia
  • Death: From cardiac arrest or respiratory failure
  • Tardive dyskinesia: Permanent movement disorders

Prevention

  • Take medications exactly as prescribed
  • Use pill organizers to prevent double-dosing
  • Store medications safely away from children
  • Inform all healthcare providers about all medications
  • Regular monitoring by healthcare providers
  • Be aware of drug interactions
  • Don't stop or change doses without medical supervision
  • Seek help for mental health crises before self-medicating
  • Educate family members about medication risks

Prognosis

The outlook for antipsychotic poisoning depends on several factors:

  • Early treatment: Better outcomes with prompt medical care
  • Amount ingested: Higher doses associated with worse outcomes
  • Type of antipsychotic: Some have more dangerous effects than others
  • Patient factors: Age, health status, and other medications
  • Complications: Development of serious complications worsens prognosis
  • Most patients recover: With appropriate treatment, most patients survive

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