Antipsychotics

Question 1

How is Schizophrenia defined/diagnosed?

Answer 1

Characterised by distortions of thinking and perception
Symptoms for at least 6 months
Both positive and negative symptoms

Question 2

What are the 4 A’s (negative symptoms) in Schiz?

Answer 2

Affective blunting
Anhedonia
Alogia
Apathy

Question 3

What are the positive symptoms of Schiz?

Answer 3

Delusions
Hallucinations
Agitation
Exaggerated/disorganised speech
Exaggerated/disorganised behaviours

Question 4

What are the anatomical characteristics of Schizophrenia?

Answer 4

Grey matter degeneration in medial temporal lobes
Enlarged ventricles and sulci
Reduced cerebral blood flow through basal ganglia and frontal lobes

Question 5

What are the classic antipsychotics (1st generation), their MOA and their most common side effect?

Answer 5

D2 antagonists

Haloperidol

Chlorpromazine

Extrapyramidal side effects due to altering nigrostriatal dopaminergic pathways (dystonias, akinesias, Parkinsonism)

Question 6

What are the atypical antipsychotics (2nd generation), their MOA and common side effects?

Answer 6

Amisulpride - 5-HT7 antagonist
Clozapine and Risperidone - 5-HT2a antagonist
All D2 antagonists

Cardiovascular side effects but more effective at treating negative symptoms

Question 7

What’s tardive dyskinesia and how can it be treated?

Answer 7

Side effect develops as a result of long term classic (typical, 1st gen) antipsychotic use

Disabling involuntary movements, chorea, grimacing, twisting

Halt anticholinergic medication and switch antipsychotic treatment to atypical (2nd gen), vitamins E and B6, benzodiazepines and B-blockers

Long term side effect of Haloperidol

Question 8

What neurotransmitter is common, but opposite, in both Parkinson’s and Schizophrenia?

Answer 8

Dopamine - deficiency in PD but excess in Schizophrenia

Question 9

What are the pathogenic pathways in Schizophrenia and Parkinson’s?

Answer 9

Schizophrenia: mesolimbic and mesocortical
PD: nigrostriatal

Question 10

What’s agranulocytosis?

What’s neuroleptic malignant syndrome?

Answer 10

Agranulocytosis = drug induced blood disorder, leukopenia commonly seen as side effect of clozapine

Neuroleptic malignant syndrome = antipsychotic side effects in patients with genetic polymorphism of D2 receptor gene (treated with DA agonists and benzos)