General about schizophrenia, affective disorders, bipolar disorder

Question 1

Types of symptoms of schizophrenia

Answer 1

Positive symptoms: Delusions, hallucinations.

Negative symptoms: Withdrawal, apathy, lack of motivation

Question 2

Neuronal pathways responsible for symptoms in schizophrenia

Answer 2

Positive symptoms: Excessive activity in mesolimbic pathways.
Negative symptoms: Insufficient activity in mesocortical pathways.

Question 3

Mechanism of the therapeutic effect of antipsychotic drugs

Answer 3

Competitive blockade of dopamine and serotonin receptors

Question 4

Changes in dopamine neurotransmission caused by antipsychotics

Answer 4

1. Increased synthesis, release and metabolism.
2. Depolarization blockade, inactivation of dopaminergic neurons.
3. Dopamine up-regulation and supersensitivity to dopamine agonists.

Question 5

Supersensitivity can cause…

Answer 5

Tarditive dyskinesia (delayed type extrapyramidal symptoms)

Question 6

Adverse effects of all antipsychotics

Answer 6

Peripheral alpha1-blockade: Dizziness, hypotension, reflex tachycardia.
Peripheral muscarinic blockade: Dry mouth, constipation, blurred vision, urinary retention.
Central histamine 1 blockade: Drowsiness, weight gain.
Neuroleptic malignant syndrome

Question 7

Neuroleptic malignant syndrome - symptoms and treatment

Answer 7

Muscle rigidity, elevated temperature, altered consciousness, autonomic dysfunction (tachycardia, diaphoresis, tachypnea, urinary and fecal incontinence).
Treatment: dantrolene, supportive care.

Question 8

Antipsychotics - indications

Answer 8

Schizophrenia, psychosis (drug-induced, mania during bipolar disease)
Agitated pts with e.g. dementia and mental retardation.
Phenothiazines: Some for vomiting and nausea.

Question 9

Treatment for acute EPSs

Answer 9

Benztropine, diphenhydramine, amantadine.

Question 10

Treatment for tarditive dyskinesia

Answer 10

Off label: amantadine, dopamine receptor agonists, clozapine, physostigmine, benzodiazepine.

Question 11

Withdrawal syndrome from antipsychotics

Answer 11

Insomnia, nightmares.
Nausea, vomiting, diarrhea.
Restlessness
Salivation, sweating.

Question 12

Groups of drugs used in affective disorder

Answer 12

Antidepressants and mood-stabilizers

Question 13

MOA for antidepressant drugs

Answer 13

Increase serotonin, norepinephrine and dopamine neurotransmission.
Increased synaptic concentration of serotonin, cause down-regulation of presynaptic autoreceptors. Increased firing rate of serotoergic neurons.

Question 14

Drugs for bipolar disorder

Answer 14

Lithium
Benzodiazepines
Antipsychotics