Antipsychotics

Question 1

What are the key characteristics of a psychotic episode?

Answer 1

1. Delusion
2. Hallucinations
3. Lack of self awareness
4. Disrupted thought patterns

Question 2

What is schizophrenia?

Answer 2

Distortions of thinking and perception
Distortions of affect (inappropriate to situation)
Disturbance lasting 6+ months
At least one month of 2+ classical symptoms (delusions, hallucinations, disorganised behaviour, negative symptoms)

Question 3

What are the 4 A’s (negative symptoms) of schizophrenia?

Answer 3

Anhedonia (lack of joy)
Affective blunting (reduction in mood)
Alogia (lack of speech)
Avolition (lack of motivation)

Question 4

What characterises disorganisation syndromes?

Answer 4

Alterations in speech, thought patterning and behaviour (thought pattern changes commonly involve thought insertion or withdrawal, thought echo and thought broadcasting)

Question 5

What are the classes of antipsychotic drugs?

Answer 5

First generation (classical/ typical)
Second generation (atypical) 
Third generation (new)

Question 6

What is the main target of first generation antipsychotics?

Answer 6

Dopamine (D2) receptors

Question 7

What is the main target of second generation antipsychotics?

Answer 7

Serotonin (5HT) receptors

[and Dopamine receptors]

Question 8

Which class of antipsychotics has a higher risk of neurological side effects?

Answer 8

First generation antipsychotics

Question 9

Which class of antipsychotics has a higher risk of metabolic side effects?

Answer 9

Second generation antipsychotics

Question 10

Which class of antipsychotics has a higher risk of extrapyramidal side effects?

Answer 10

First generation antipsychotics

Question 11

What are the 4 main dopamine pathways within the CNS?

Answer 11

Mesocortical
Mesolimbic
Nigrostriatal
Tuberohypophyseal

Question 12

What behaviours are associated with the prefrontal cortex?

Answer 12

Judgement 
Personality
Reasoning 
Positive emotions 
Planning

Question 13

What behaviours are associated with the limbic system?

Answer 13

Negative emotions 
Sensory perception 
Spatial awareness
Memory 
Social recognition

Question 14

Which antipsychotic drugs are first generation?

Answer 14

Haloperidol

Chlorpromazine

Question 15

Which antipsychotic drugs are second generation?

Answer 15

Aripirazole
Clozapine
Amisulpride
Risperidone

Question 16

What other receptors (aside from D2) can first generation antipsychotics act as antagonists on?

Answer 16

Histamine (H1)
Muscarinic (M1)
Alpha-1 Adrenergic

Question 17

What side effects are associated with 5HT antagonists?

Answer 17

Constipation
Dizziness
Weight gain
Drowsiness

Question 18

What side effects are associated with D2 antagonists?

Answer 18

Rigidity
Tremor
Slow speech
Stiffness

Question 19

What is the ‘gold standard’ antipsychotic?

Answer 19

Clozapine

Question 20

What is the nigrostriatal pathway?

Answer 20

One of the major dopamine pathways in the brain

Efferent connection between the substantia nigra and corpus striatum

Question 21

What is the extrapyramidal system?

Answer 21

Part of the motor system causing involuntary movements.

Includes the rubrospinal, reticulospinal, tectospinal and vestibulospinal tracts as well as the basal ganglia.

Question 22

What symptoms characterise Tardive Dyskinesia?

Answer 22

Involuntary movement
Protruding tongue
Grimacing
Twisting of the face and limbs

Question 23

What symptoms characterise Neuroleptic Malignant Syndrome?

Answer 23

High fever
Autonomic dysfunction
Altered consciousness

Question 24

What are the 5 domains of symptoms exhibited by people with schizophrenia?

Answer 24

1. Positive symptoms
2. Negative symptoms
3. Anxiety/ depression
4. Cognition symptoms
5. Aggressive symptoms

Question 25

What side effects can you get from 1st gen antipsychotics due to their antagonist effects on Muscarinic (M1) receptors?

Answer 25

Constipation Blurred vision Dry mouth

Question 26

What side effects can you get from 1st gen antipsychotics due to their antagonist effects on Histamine (H1) receptors?

Answer 26

Weight gain | Sedation

Question 27

What side effects can you get from 1st gen antipsychotics due to their antagonist effects on Dopaminergic (D2) receptors?

Answer 27

Prolactin elevation Rigidity Slow movements

Question 28

What side effects can you get from 1st gen antipsychotics due to their antagonist effects on alpha1 andrenergic receptors?

Answer 28

Hypotension | Drowsiness

Question 29

Changes in which dopamine pathway can result in elevation of prolactin levels?

Answer 29

Tuberohypophyseal

Question 30

How might an increase prolactin level present in patients?

Answer 30

Enlargement of breasts Increased lactation Irregular menstrual cycle (due to oestrogen deficiency) Erectile dysfunction and infertility (due to testosterone deficiency)

Question 31

Which group of side effects are more apparent in 2nd gen antipsychotics?

Answer 31

Cholinergic effects

Question 32

Which symptoms are classed as extrapyramidal side effects?

Answer 32

Slowed movement Tremor Akathisia (restlessness/ inability to stay still) Sedation

Question 33

Which hyperkinetic disorders can be treated with antipsychotics?

Answer 33

``` Huntingdon's Disease Dystonia Restless leg syndrome Choreoathetosis Sydenham Chorea ```

Question 34

Why do antipsychotics cause Tardive Dyskinesia?

Answer 34

Down-regulation of dopamine system and increased glutamatergic transmission resulting in oxidative neurodegeneration

Question 35

Which dopamine pathway is involved in controlling movement?

Answer 35

Nigrostriatal

Question 36

Which 2 basal ganglia nuclei form the striatum?

Answer 36

Putamen | Caudate nucleus

Question 37

What is the dopamine hypothesis of schizophrenia?

Answer 37

Caused by excessive DA release in the mesolimbic pathway (causes positive symptoms) Hypoactivity of DA in mesocortical responsible for negative/ cognitive/ affective symptoms)

Question 38

What anatomical changes are seen in patients with schizophrenia?

Answer 38

Degeneration of grey matter (esp. medial temporal lobes) Enlarged ventricles and sulci (esp. medial temporal lobes) Reduced blood flow in basal ganglia and frontal lobes

Question 39

How can Tardive Dyskinesia be managed?

Answer 39

Decrease symptoms through supplement use (Vit E and Vit B6), Benzodiazepines and Beta-Blockers [Nb. no definitive cure for TD, can spontaneously remit]

Question 40

What causes Neuroleptic Malignant Syndrome?

Answer 40

Genetic polymorphism of D2 receptor gene present in approx. 15% of schizophrenic patients Onset of syndrome after starting antipsychotic treatment