Schizophrenia Flashcards
What are the positive symptoms?
Auditory hallucinations
Delusions
Thought disorder
What are the negative symptoms?
Lack of drive
Social withdrawal
Impaired cognition
What are the candidate NTs?
5HT, glutamate, DA
Which dopamine receptor family is involved in SCZ and what is its overall effect?
D2 family - inhibitory
What is the evidence for the DA hypothesis?
Amphetamines - displace DA in neuron termnal - DA release - positive SCZ symptoms
D2-like DA agonists (e.g. bromocriptine) - - positive SCZ symptoms
Reserpine + D2-like DA antagonists - reduce positive SCZ symptoms - antipsychotics
Name a typical neuroleptic and its effect
Chlorpromazine - D2R antagonist (alpha1, H1, mACh anatagonist)
What are the side effects of neuroleptics (typicals)?
Extrapyramidal symptoms - Parkinsonian-like, dystonia (head/trunk spasm), tardive dyskinesia (involuntary face movements), akathisia (involuntary motor restlessness)
Hyperprolactinaemia
Sedation
Autonomic effects - dry mouth, postural hypotension
Aplastic anaemia
Neuroleptic malignant syndrome
What is the defining effect of atypical neuroleptics?
D2 and 5HT2 antagonism
What are the advantages of atypicals?
Fewer EPS
Positive and negative symptoms treated
Less tardive dyskinesia
Treats drug-resistant psychosis
What are the side effects of atypicals?
Hyperprolactinaemia
Autonomic effects - postural hypotension
QT interval prolongation
Metabolic effects - weight gain, hypercholesterolaemia
Name a 3rd gen antipsychotic and its effects
Apiprazole - D2 partial agonist (low efficacy, higher affinity than endogenous DA), 5HT2A antagonist
What are the advantages of apiprazole?
Few EPS
Little weight gain
Few QT interval abnormalities
Safe in overdose
What are the disadvantages of apiprazole?
Hyperprolactinaemia
Hypercholesterolaemia
Possibly akathisia
Which type of drugs are used as a first-line treatment?
Atypicals
