17) Psychosis

Question 1

Schizophrenia

Answer 1

• Mental illness that causespsychosis (hallucinations and delusions),and other symptoms

Question 2

Schizophrenia is characterized by

Answer 2

• Thoughts/experiences that seem out of touch with reality
• Disorganized speech or behavior
• Decreased participation in daily activities
• Difficulty with concentration and memory may also be present

Question 3

Bipolar disorder

Answer 3

• Generally alternatebetweenperiods of low and high moods

Question 4

Drugs used to treat psychosis (antipsychotics)

Answer 4

• Classic drugs (D2 receptor affinity)

- Newer agents (5HT2 receptor affinity)

Question 5

Antipsychotic classic drugs (D2 receptor affinity) names

Answer 5

• Chlorpromazine
• Fluphenazine
• Haloperidol
• Thioridazine
• Triffluoperazine

Question 6

Newer antipsychotic agents (5HT2 receptor affinity) names

Answer 6

• Clozapine
• Olanzapine
• Quetiapine
• Risperidone
• Ziprasidone
• Others

Question 7

Classic bipolar drug name

Answer 7

• Lithium

Question 8

Newer bipolar agents

Answer 8

• Carbamazepine
• Clonazepam
• Olanzapine
• Valporic acid
• Others

Question 9

Hyperactivation of the dopaminergic mesolimbic pathway induces

Answer 9

• Positive symptoms of schizophrenia

- Via increased D2 receptor stim in limbic areas

Question 10

Hypoactivation of dopaminergic mesocortical pathway causes

Answer 10

• Negative and cognitive symptoms of schizophrenia

- Decreased D1 receptor activation in cortical areas

Question 11

Ideal treatment regimen

Answer 11

• Decrease mesolimbic activation

- Increase cortical stimulation

Question 12

Changing in other pathways’ activity (tuberoinfindibular and nigrostriatal pathways) are responsible for

Answer 12

• Side effect of current antipsychotics

Question 13

The antipsychotic drugs are well absorbed when given orally because they are

Answer 13

• Lipid soluble

- Readily enter CNS and most tissues

Question 14

Many antipsychotics are bound extensively to

Answer 14

• Plasma proteins

Question 15

Antipsychotics require metabolism by _____ before elimination

Answer 15

• Liver enzymes

- Long plasma half-lives permit once-daily dosing

Question 16

There is a correlation between blockade of D2receptors and

Answer 16

• Extrapyramidal dysfunction

Question 17

Most of the second generation (atypical) antipsychotic agents have higher affinities for

Answer 17

• Other receptors than for the D2receptor

Question 18

First vs. second generation antipsychotic naming

Answer 18

• First = typical

- Second = atypical

Question 19

Most of the atypical drugs cause less _____ than the first-generation agents

Answer 19

• Extrapyramidal dysfunction

Question 20

With the exception of haloperidol, all antipsychotic drugs block

Answer 20

• H1receptors to some degree

Question 21

Clozapine affinity

Answer 21

• D4and 5-HT2blocking
• Virtually no D2affinity

Question 22

Many of the atypical drugs (eg,olanzapine, quetiapine,andrisperidone) also have high affinity for

Answer 22

• 5-HT2Areceptors

- May also interact with D2and others

Question 23

Ziprasidoneagonist/antagonist activity

Answer 23

• Antagonist: D2, 5-HT2A, 5-HT1D

- Agonist: 5-HT1A

Question 24

Aripiprazole agonist/antagonist activity

Answer 24

• Partial agonist: D2, 5-HT1A
• Strong antagonist: 5-HT2A

Question 25

Invega blocks _____ receptors

Answer 25

- Alpha-2

Question 26

Extrapyramidal toxicity occurs most frequently with

Answer 26

- Haloperidol | - Piperazine (more potent) side-chain phenothiazines

Question 27

Side effects of antipsychotics

Answer 27

- Reversible neurological events (extrapyramidal toxixity) - Tardive dyskinesia (lips and buccal cavity) - Autonomic effects - Atropine-like effects - Endocrine/metabolic effects - Weight gain and hyperglycemia

Question 28

Autonomic side effects of antipsychotics result from blocking

Answer 28

- Peripheral muscarinic receptors and α adrenoceptors | - Leads to postural hypotension

Question 29

Atropine-like side effects of antipsychotics

Answer 29

- Dry mouth, constipation, urinary retention, visual problems - Pronounced with thioridazine and phenothiazines with aliphatic side chains (eg, chlorpromazine)

Question 30

Endocrine and metabolic side effects of antipsychotics

Answer 30

- Hyperprolactinemia, gynecomastia, amenorrhea-galactorrhea syndrome, and infertility - Most are predictable manifestations of dopamine D2 receptor blockade in the pituitary (dopamine is the normal inhibitory regulator of prolactin secretion)

Question 31

Significant weight gain and hyperglycemia occur as antipsychotic side effects due to

Answer 31

- Diabetogenic action with several of the second- generation agents (especially clozapine and olanzapine) - Aripiprazole and ziprasidone have little or no tendency to cause hyperglycemia, hyperprolactinemia, or weight gain

Question 32

Malignant hyperthermic syndrome symptoms

Answer 32

- Muscle rigidity - Impairment of sweating - Hyperpyrexia - Autonomic instability, which may be life threatening

Question 33

Sedation as an antipsychotic side effect is more marked with

Answer 33

- Phenothiazines (especially chlorpromazine)

Question 34

Miscellaneous toxicities associated with antipsychotics

Answer 34

- Visual impairment caused by retinal deposits (thioridazine) - Conduction defects/fatal ventricular arrhythmias (thioridazine @ high doses) - Prolonged QT interval (atypicals) - Agranulocytosis (clozapine) - Seizures also seen with clozapine @ high doses

Question 35

Lithium is effective in treatment of

Answer 35

- Manic phase of bipolar disorder

Question 36

Lithium is distributed throughout the body water and cleared by

Answer 36

- Kidneys - Half-life is about 20 h - MOA not well defined

Question 37

Plasma lithium levels should be monitored (therapeutic levels vs. maintenance)

Answer 37

- Target therapeutic plasma concentration (for acute symptoms) = 0.8–1.2 mEq/L - Maintenance = 0.4–0.7 mEq/L

Question 38

Lithium side effects

Answer 38

- Tremor, sedation, ataxia, and aphasia - Thyroid enlargement - Reversible nephrogenic diabetes insipidus (occurs commonly at therapeutic drug levels) - Edema - Acneiform skin eruptions - Leukocytosis - Teratogenic