Antipsychotics Flashcards
(50 cards)
What are some indications of antipsychotics?
- Recurrent suicidal behavior
- Hallucinations/Delusions associated with Parkinson Disease psychosis
What is the dopamine hypothesis?
- Chlorpromazine serendipitously found to have antipsychotic activity
- Direct/indirect DA-agonists provoke psychotic reactions in non-schizophrenics and exacerbate symptoms in schizophrenics
- PET studies have revealed alterations in DA-mediated transmission in schizphrenics
What are positive symptoms of schizophrenia?
- Hallucinations
- Delusions
- Disorganized speech/thinking
- Agitation
- Abnormal motor behavior
What is the anatomy of the mesolimbic pathway in schizophrenia?
- Projections from the ventral tegmental area to the nucleus accumbens
What is the physiology of the mesolimbic pathway schizophrenia?
- Motivation
- Emotions
- Reward
- Positive symptoms of schizophrenia
What is the anatomy of the mesocortical pathway in schizophrenia?
- Projections from the ventral tegmental area to the cortex
What is the physiology of the mesocortical pathway in schizophrenia?
- Cognition and executive functions
- Emotions and affect
What are the implications of the mesolimbic pathway in schizophrenia?
- D2 antagonists reduce positive symptoms of schizophrenia
What are the implications of the mesocortical pathway in schizophrenia?
- Hypofunction of the mesocortical pathway might be related to cognitive and negative symptoms in schizophrenia
What are the negative symptoms of schizophrenia?
- Apathy
- Avolition
- Alogia
- Cognitive deficits
- Social withdrawal
What is the anatomy of the nigrostriatal pathway and EPS?
- Projections from substantia nigra to striatum
What is the physiology of the nigrostriatal pathway and EPS?
- Stimulation of purposeful movement
What are the implications of the nigrostriatal pathway and EPS?
- D2 antagonism induces extrapyramidal symptoms (pseudoparkinsonism)
What is the anatomy of the tuberoinfundibular pathway and prolactin release?
- Hypothalamus to infundibular region
What is the physiology of the tuberoinfundibular pathway and prolactin release?
- Dopamine is released into the portal circulation connecting the median eminence with the anterior pituitary gland
- Dopamine tonically inhibits prolactin release
What are some implications of the tuberoinfundibular pathway and prolactin release?
- D2 antagonism increases prolactin levels
What are the four dopaminergic pathways?
- Mesolimbic pathway
- Mesocortical pathway
- Nigrostriatal pathway
- Tuberoinfundibular pathway
What is the schizophrenia hypotheses?
- Limits to dopamine hypothesis
1. Does not account for all cognitive deficits/negative symptoms associated with schizophrenia
2. Does not fully explain role of other neurotransmitters or other receptors
- What is the glutamate disorder hypothesis?
- NMDA receptor antagonists can manifest select aspects of schizophrenia
- Agents that modulate glycine modulatory site NMDA/AMPA receptor reduce some cognitive symptoms of schizophrenia
- Cognitive symptoms may be due to low activity of NMDA/AMPA receptor on GABA inhibitor interneurons in prefrontal cortex
What is the early-life neurodevelopmental disorder hypothesis?
- Youth/adolescence genetic/environmental impact during pivotal neurodevelopmental stages leads to later-life symptoms and presentation of worsening impacts
What do the therapeutic choices start with when treating psychotic disorders?
- Previous dosing history
- Tolerance to known side effects
What is the minimum therapy necessary in order to evaluate response to therapy?
- 2-3 weeks
- Max benefit may take several months
What is the best for rapid response in treating psychotic disorders?
- Injectable versions
- Acute high doses are not universally beneficial
When is favorable prognosis seen in treating psychotic disorders?
- Shorter duration and less severe symptoms of disease prior to diagnosis/treatment]
- Strong, positive pre-illness functionality
