SCHIZOPHRENIA mastered version

Question 1

all dopamine receptors are ___________

Answer 1

All are metabotropic (G-protein coupled)

Question 2

Therapeutic potency of Antipychotic drugs does not correlate with their ____________________

Answer 2

Therapeutic potency of Antipychotic drugs does not correlate with their affinity for binding the D1 receptor

Question 3

Binding affinity for D2 receptors is strongly correlated with ________________

Answer 3

Binding affinity strongly correlated with antipsychotic potency and extrapyramidal effects

Question 4

Activation of D2 receptors in rats leads to?

Answer 4

Activation of D2 receptors 🡺 increased motor activity and stereotypes behaviour in rats.

Question 5

Antipsychotic agents block ___________

Answer 5

Antipsychotic agents block D2 receptors

Question 6

what brain regions for D1?

Answer 6

Putamen
Nucleus Accumbens
Olfactory tubercle

Question 7

what brain regions for D5?

Answer 7

hippocampus and hypothamus

Question 8

what brain regions for D2?

Answer 8

nearly the same as D1 but pre and post synapse
pre- and post-synaptically on neurons caudate-putamen; nucleus accumbens; olfactory tubercle

Question 9

what brain regions for D3?

Answer 9

frontal cortex; medulla; midbrain

Question 10

Q: What are the main categories of drug therapy for schizophrenia?

Answer 10

A: First-generation (‘typical’) and second-generation (‘atypical’) antipsychotics.

Question 11

Q: What are some first-generation antipsychotics?

Answer 11

A: Chlorpromazine, haloperidol, fluphenazine, flupenthixol, clopenthixol.

Question 12

Q: What are some second-generation antipsychotics?

Answer 12

A: Clozapine, risperidone, sertindole, quetiapine, amisulpride, aripiprazole, zotepine.

Question 13

Q: What is the difference between typical and atypical antipsychotics?

Answer 13

A: Differences are based on receptor profile, incidence of extrapyramidal side effects (less in atypical), efficacy in treatment-resistant patients, and efficacy against negative symptoms.

Question 14

Q: What are some characteristics of chlorpromazine?

Answer 14

A: It has pronounced sedative effects which wear off with repeated administration, moderate anti-muscarinic and extrapyramidal side effects, endocrine, hypotensive side effects, and is relatively inexpensive.

Question 15

what are extrapyramidal effects

Answer 15

Akathisia: Feeling restless like you can’t sit still. …

Dystonia: When your muscles contract involuntarily. …

Parkinsonism: Symptoms are similar to Parkinson’s disease. …

Tardive dyskinesia: Facial movements happen involuntarily.

Question 16

Q: How is clozapine distinguished among second-generation antipsychotics?

Answer 16

A: It has greater affinity for 5HT2 receptors than D2, is effective against negative and positive symptoms, has no extrapyramidal side effects but comes with the risk of agranulocytosis, and is licensed for use in treatment-resistant schizophrenia.

Question 17

Q: What are some characteristics of risperidone?

Answer 17

A: It has greater affinity for 5HT2 receptors than D2, broad efficacy, is more potent than clozapine, and has little to no extrapyramidal, autonomic nervous system, and cardiac side effects at low doses.

Question 18

Q: What are some advantages of second-generation agents over first-generation agents?

Answer 18

A: They cause little to no extrapyramidal side effects, are effective against positive and negative symptoms, and can be used in treatment-resistant patients.

Question 19

Q: What are some non-psychiatric indications for antipsychotics?

Answer 19

A: They can be used as anti-emetics and sedatives.

Question 20

Q: What are some neurological adverse events of antipsychotics?

Answer 20

A: They can cause extrapyramidal reactions like acute dystonia and tardive dyskinesia, and seizures.

Question 21

Q: What are some autonomic nervous system effects of antipsychotics?

Answer 21

A: They can cause anti-muscarinic effects like loss of accommodation, dry mouth, difficulty urinating, constipation, and adreno-receptor blocking effects like orthostatic hypotension, and impotence.

Question 22

Q: What are some metabolic and endocrine effects of antipsychotics?

Answer 22

A: They can cause weight gain, hyperglycaemia secondary to insulin resistance, and hyperprolactinaemia.

Question 23

Q: What are some cardiac effects of antipsychotics?

___________can cause ventricular arrhythmias, cardiac conduction block, and sudden death, while _____________ carries the greatest risk of ECG effects like QT prolongation.

Answer 23

A: Thioridazine can cause ventricular arrhythmias, cardiac conduction block, and sudden death, while ziprasidone carries the greatest risk of ECG effects like QT prolongation.

Question 24

Q: What are some toxic or allergic reactions to antipsychotics?

Answer 24

A: Agranulocytosis (especially with clozapine), jaundice, and skin eruptions.

Question 25

which first generation drugs are in group 1 of the phenothiazine class

Answer 25

chlorpromazine; levomepromazine; promazine

Question 26

which first generation drugs are in group 2 of the phenothiazine class

Answer 26

pericyazine; pipotiazine

Question 27

which first generation drugs are in group 3 of the phenothiazine class

Answer 27

fluphenazine; prochlorperazine

Question 28

Q: What are some behavioral effects of antipsychotics?

Answer 28

A: Older agents can cause pseudodepression and a toxic confusional state.

Question 29

Q: What is the Butyrophenone class of first-generation antipsychotics and what are its characteristics?

Answer 29

A: Haloperidol falls into this class. It has high D2 receptor affinity, is a potent antipsychotic, but can cause severe extrapyramidal side effects, though less anticholinergic and hypotensive side effects.

Question 30

Q: What are some characteristics of Aripiprazole?

Answer 30

A: It is fairly new, a partial agonist at D2 receptor, has limited side effect profile, and has a long half-life.

Question 31

Q: What are NICE guidelines on the use of atypical antipsychotics?

Answer 31

A: They are considered when choosing therapy for "newly diagnosed" psychotic patients, for management of an acute schizophrenic episode, for patients experiencing unacceptable side effects of conventional antipsychotics, and for patients in relapse whose symptoms were previously inadequately controlled.

Question 32

Q: What are some characteristics of group 3 phenothiazines?

Answer 32

they have fewer sedative and anti-muscarinic effects, and pronounced extrapyramidal side effects.

Question 33

Q: What are some characteristics of pericyazine and pipotiazine?

Answer 33

A: they have moderate sedative effects, severe anti-muscarinic but fewer extrapyramidal side effects.

Question 34

Q: What are the side effects of clozapine?

Answer 34

A: It can cause agranulocytosis, lower seizure threshold, and weight gain.

Question 35

Q: How does Olanzapine compare to Clozapine?

Answer 35

A: Olanzapine is similar to Clozapine in its effects but doesn't carry a risk of agranulocytosis.

Question 36

Q: What is the use of Prochlorperazine?

Answer 36

A: Prochlorperazine is used mainly as an anti-emetic by blocking dopamine receptors centrally and peripherally in the stomach.

Question 37

Q: What are some behavioral side effects of older antipsychotic agents?

Answer 37

A: Older agents can be unpleasant to take and can cause pseudodepression and toxic confusional states.

Question 38

25. Q: What are the properties of drugs from Group 1 of the Phenothiazine class, like chlorpromazine?

Answer 38

A: They have binding affinities for different receptors (D2, adrenergic > H1, mACh, 5-HT2), have pronounced sedative effects, moderate anti-muscarinic and extrapyramidal side effects, and endocrine/hypotensive side effects.

Question 39

Q: What is a distinctive characteristic of clozapine in terms of its receptor affinity?

Answer 39

A: Clozapine has a greater affinity for 5HT2 receptors than D2, and it is a potent antagonist at D4-receptors.

Question 40

Q: When is clozapine introduced according to NICE guidelines?

Answer 40

A: Clozapine is introduced if schizophrenia is inadequately controlled despite the sequential use of 2 or more antipsychotics (one of which should be 2nd generation) each for 6-8 weeks.

Question 41

Q: What is a potential life-threatening side effect of clozapine and how is it monitored?

Answer 41

A: Agranulocytosis is a potential life-threatening side effect of clozapine, hence regular blood tests are required.

Question 42

. Q: What is the significant risk associated with Thioridazine and Ziprasidone in terms of cardiac effects?

Answer 42

A: Thioridazine can cause ventricular arrhythmias, cardiac conduction block, and sudden death, while Ziprasidone carries the greatest risk of ECG effects like QT prolongation.

Question 43

schizophrenia positive symptoms?

Answer 43

Delusions Hallucinations Disorganised speech Grossly disorganized or catatonic behaviour

Question 44

schizophrenia negative symptoms

Answer 44

Reduced expression of emotion Poverty of speech Difficulty in initiating goal-directed movements Cognitive/Memory impairment