AntiPsychotics

Question 1

Name some Type 1 / Typicals

Answer 1

Haloperidol, Chlorpromazine

Question 2

Name some Type 2/Atypicals

Answer 2

Quetiapine, Olanzepine, Clozapine

Question 3

What are the main dopamine pathways

Answer 3

1. Mesocortex: ventral tegmental area to frontal cortex
2. Mesolimbic: ventral tegmental area to limbic system
3. Nigrostriatal: pars compacta to caudate / putamen
4. Tuberoinfundibulum: arcuate nucleus of hypothalamus to pituitary gland

Question 4

Symptoms of schizophrenia

Answer 4

Positive symptoms:

• Delusions - fixed false beliefs
• Hallucinations - false sensations without external stimuli
• Disorganised thought
• Inappropriate behaviour

Negative symptoms:

• Apathy
• Blunted affect

==> social and functionally disabling

Question 5

Extrapyradimidal signs

Answer 5

Dystonia - abnormal posture tone
Akisthisa - restlessness
Pseudoparkinsonism - bradykinesia, rigidity, resting tremor
Tardive dyskinesia - pointless continous movements, typically involving the face, mouth, upper limb

Question 6

Other side effects that you want to look out for

Answer 6

1) Neuroleptic malignant syndrome - massive dopamine blockade induced
- sweats, fevers, autonomic dysfunction, muscle rigidity, mental state changes

2) Metabolic syndrome
- dyslipidemia, hypercholesterolemia, hyperglycemia (T2DM), weight gain

3) Agranulocytosis - check for WCC differentials, particularly basophils, eosinophils, neutrophils

4) Hyperprolactinemia
- gynaecomastia, changes in libido, menstrual changes

5) Anti-cholinergic:
- urinary retention, constipation, dry mouth

Question 7

Counselling

Answer 7

upon commencement - takes about 4-6 weeks to take effect; 1-2 weeks overlapping change if need to trial other medications

Question 8

What is treatment-resistant schizophrenia?

Answer 8

If you’ve trialled 2 anti-psychotics for 6-12 weeks at optimal dosage and failed to have improvement
–> Clozapine (but side effects +++)

Question 9

Last resort

Answer 9

Electroconvulsive therapy (ECT)