17. Drugs for Schizophrenia and Bipolar Disorder

Question 1

what are the types of schizophrenia?

Answer 1

Paranoid
Catatonic
Undifferentiated

Question 2

What genes have been found to have a correlation with schizophrenia?

Answer 2

GRIN2A
GRIA3
Both code for glutamate receptor

Question 3

What are the positive symptoms of schizophrenia?

Answer 3

Hallucinations
Delusions
Disorganised behaviour and speech

Question 4

What are the negative symptoms of schizophrenia?

Answer 4

Apathy
Anhedonia
Blunted effect
Poverty of speech

Question 5

What are the cognitive symptoms of schizophrenia?

Answer 5

Thought disorders

bizarre behaviour

Question 6

What is the dopamine hypothesis of schizophrenia?

Answer 6

Dopamine agonists and drugs that increase dopamine (eg. cocaine, amphetamines) have psychomimetic effects
Dopamine antagonists relieve positive symptoms

Question 7

Name 2 typical/first generation antipsychotics

Answer 7

Chlorpromazine

Haloperidol

Question 8

What receptor is blocked by typical antipsychotics?

Answer 8

D2 receptor: relieves positive symptoms

Question 9

How long does it take for typical antipsychotics to have full effect?

Answer 9

2-4 weeks

Question 10

What is the main side effect associated with typical antipsychotics?

Answer 10

Extrapyramidal syndrome

Question 11

What is extrapyramidal syndrome?

Answer 11

‘pseudoparkinsonism’

Can be acute or tardive

Question 12

What are the symptoms of acute extrapyramidal syndrome?

Answer 12

Dystonia
Parkinsonism
Akathisia (restlessness)

Question 13

What are the symptoms of tardive extrapyramidal syndrome?

Answer 13

Dyskinesia (ranging from sticking out tongue to twisting of whole body)

Question 14

What are the other side effects associated with typical antipsychotics?

Answer 14

Anticholinergic: dry mouth, urinary retention
Behavioural: apathy, lack of initiative
CV: orthostatic hypotension
Prolactin secretion
Neuroleptic Malignant Syndrome

Question 15

What is Neuroleptic Malignant Syndrome?

Answer 15

Muscle rigidity and rapid increase in body temp

Question 16

Name 3 atypical antipsychotics

Answer 16

Clozapine
Risperidone
Olanzapine

Question 17

What receptors are targeted by atypical antipsychotics?

Answer 17

5-HT2>D2

Question 18

What are the advantages of atypical antipsychotics over typical antipsychotics?

Answer 18

Atypical are effective for both positive and negative symptoms
Atypical are selective for D2 in the mesolimbic system rather than nigrostrial so don’t cause extrapyramidal syndrome

Question 19

What are the side effects of atypical antipsychotics?

Answer 19

Sexual dysfunction
Skin problems
Obesity, hypertension, hyperlipidaemia, DM
Olanzapine and risperidone increase risk of stroke in elderly

Question 20

Which drugs are used to treat mania in bipolar disorder?

Answer 20

Antipsychotics
Lithium and Na+ anticonvulsants also useful to prevent cycling
Electroconvulsive therapy

Question 21

Which anticonvulsants are useful in bipolar disorder?

Answer 21

Carbamezepine
Valproate
Lamotrigine

Question 22

What is the MOA of lithium?

Answer 22

Mimics role of Na+ in excitable tissue to decrease excitability

Question 23

What concentration of lithium is toxic?

Answer 23

> 2mmol
Narrow TI
Interactions with diuretics and NSAIDs

Question 24

How long does it take for lithium to work?

Answer 24

1-2 weeks

Question 25

What are the side effects of lithium?

Answer 25

Tremor, teratogenic
GIT, renal
Coma, convulsions

Question 26

What drugs are used to treat depressive episodes in bipolar disorder?

Answer 26

Anti-depressants: lack efficacy and usually combined with a mood stabiliser, TCAs and SSRIs can precipitate mania
Lamotrigine is used to prevent depressive episodes

Question 27

What combination of drugs are used to prevent relapse in bipolar disorder?

Answer 27

Lithium

+ valproate, carbamazepine and lamotrigine