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Psych CASC / OSCEPsychopharmacology — first-generation antipsychotics

Psych CASC / OSCE · Psychopharmacology — first-generation antipsychotics

Explaining a first-generation antipsychotic and EPS risks (CASC)

CASC-style communication station: balanced explanation of FGA efficacy evidence (CATIE/CUtLASS), potency and EPS/TD risks, modern low-dose practice, monitoring, when depot helps, and when clozapine is the next step if resistance emerges.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 29-year-old man with schizophrenia is offered a switch from olanzapine (marked weight gain) to a first-generation option (oral haloperidol low dose or mid-potency alternative, with depot discussed if adherence fails). He says: 'Aren't those old drugs that give you Parkinson's and lock-jaw? I only want the new ones.'

Station instructions (candidate)

You have 7 minutes. Explain why a first-generation antipsychotic is being considered after metabolic harm on olanzapine, what major trials say about effectiveness and quality of life versus “newer” drugs, what movement side effects to watch for (stiffness, restlessness, rare lock-jaw emergency), how low modern dosing and monitoring reduce risk, and that long-term abnormal movements are more common with older drugs but can occur with newer ones too. Offer choice, written information, and a clear safety net. Do not coerce depot. Do not guarantee zero side effects. Do not dismiss his fears.[1][2][3]

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References5ShowHide
  1. [1]Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia N Engl J Med, 2005.PMID 16172203
  2. [2]Jones PB, Barnes TR, Davies L, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1) Arch Gen Psychiatry, 2006.PMID 17015810
  3. [3]Carbon M, Kane JM, Leucht S, Correll CU Tardive dyskinesia risk with first- and second-generation antipsychotics in comparative randomized controlled trials: a meta-analysis World Psychiatry, 2018.PMID 30192088
  4. [4]Barnes TR A rating scale for drug-induced akathisia Br J Psychiatry, 1989.PMID 2574607
  5. [5]Howes OD, McCutcheon R, Agid O, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology Am J Psychiatry, 2017.PMID 27919182
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