Psychosis

Question 1

• positive symptoms: hallucinations, delusions, disorganized or incoherent thought
• negative: flat affect, social isolation, alogia poverty of speech, avolition, anhedonia, cognitive deficits
• neurodevelopmental, 50% heritability, abberant dopaminergic/glutamatergic/serotongergic activity

Answer 1

schizophrenia

Question 2

positive symptoms arise from hyperactivity of one or more of the CNS systems, possibly mesolimbic and mesocortical

Answer 2

dopamine

Question 3

_______ can cause psychosis and make schizophrenics worse

Answer 3

amphetamine

Question 4

these receptors mediate hallucinogenic effects

Answer 4

serotonin (5-HT2a,2c)

Question 5

phenylcyclidine and ketamine produce effects that resemble aspects of schizophrenia and exacerbate symptoms in schizo, related to this NT

Answer 5

glutamate

Question 6

all antipsychotics are _______ receptor antagonists

Answer 6

D2 dopamine

Question 7

• sedation, decreased agitation
• positive symptoms improve over weeks to months (problem w/ dopamine hypothesis)
• negative symptoms may be improved by newer drugs
• antiemetic due to blockade of dopamine receptors in chemoreceptor trigger zone, not useful for motion sickness

Answer 7

pharmacological effects of antipsychotics

Question 8

• extrapyramidal effects (EPS)
• dystonia (1-5 days), unknown painful muscle cramps
• akathisia (5-60 days), unknown motor restlessness
• parkinsonian symptoms (5-30 days), tremor rigidity and bradykinesia due to blockade of striatal dopamine receptors, can be treated w/ anticholinergics

Answer 8

early antipsychotic side effects

Question 9

• increased prolactin release
• orthostatic hypotension
• weight gain
• metabolic syndrome, diabetes (treat w/ olanzepine)
• decreases seizure threshold
• neuroleptic malignant syndrome (treat w/ dantrolene)

Answer 9

side effects of antipsychotics

Question 10

• tardive dyskinesia (abnormal movements and facial disfugurement), frequently irreversible, maybe due to long term dopaminergic receptor blockade
• perioral tremor (rabbit syndrome)
• agranulocytosis with clozapine

Answer 10

long term antipsychotic side effects

Question 11

• effective against positive but not negative symptoms
• produce EPS and tardive dyskinesia
• all D2 antagonists

Answer 11

typical antipsychotics

Question 12

chlorpromazine, fluphenazine, and thioridazine are in what drug class?

Answer 12

phenothiazines

Question 13

historically most widely prescribed antipsychotic, relatively more selective for dopamine receptors than most of typical antipsychotics, highest incidence of EPS

Answer 13

haloperidol

Question 14

• no EPS or tardive dyskinesia

- antagonist at 5HT2 receptors

Answer 14

atypical antipsychotics

Question 15

• activity at broad spectrum of receptors
• no EPS or tardive dyskinesia
• some effect on negative symptoms
• agranulocytosis in 3%
• approved only for treatment resistant patients

Answer 15

clozapine

Question 16

• significant 5-HT2 antagonist activity
• generally improved side effect profile, fewer extraneous receptor interactions
• less EPS

Answer 16

newer antipsychotics (risperidone, lurasidone)

Question 17

• newer antipsychotics
• high incidence of weight gain and metabolic syndrome
• may improve negative symptoms

Answer 17

olanzapine, quetiapine

Question 18

• newer antipsychotic

- D2, 5-HT2a, 5-HT1d antagonist

Answer 18

ziprasidone

Question 19

• newer antipsychotic
• D2, 5HT1a partial agonist
• 5HT2a antagonist
• partial agonism at D2 receptors may allow for sufficient stimulation to prevent EPS, while preventing overstimulation

Answer 19

aripiprazole

Question 20

• management of agitation and psychotic symptoms in acute mania and bipolar
• delirum, demantia
• alcoholic hallucinations (NOT during withdrawal, increased risk of seizures)
• bipolar maintenance
• dopamine agonist induced psychotic symptoms
• tourettes, huntington’s
• refractory depression

Answer 20

other uses of antipsychotics