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NSB Lectures > Treatment of Psychosis and Psychotic Disorders > Flashcards

Treatment of Psychosis and Psychotic Disorders Flashcards

1
Q

How many dopaminergic pathways are in the brain?

A

4

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2
Q

What are the four dopaminergic pathways?

A

Mesolimbic

Mesocortical

Nigrostriatal

Tuberoinfundibular

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3
Q

What is the mesolimbic system regulate?

A

The limbic system

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4
Q

What is the mesolimbic system responsible for?

A

Reward processing (pleasure)

Salience (threat evaluation)

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5
Q

Where does the mesolimbic pathway run?

A

From the ventral segmental area to the nucleus accumbens & striatum (midbrain)

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6
Q

What is salience?

A

The brain’s ability to attune to relevant stimuli and block our irrelevant stimuli

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7
Q

How does psychosis arise from the mesolimbic pathway?

A

Mesolimibic pathway becomes hyperactive - dysfunction means that the brain’s salience mechanism becomes dysfunctional.

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8
Q

How do drugs of abuse affect the mesolimbic pathway?

A

They target the reward processing part = pleasure feelings.

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9
Q

What can chronic drug use cause?

A

Dysregulation of the salience part of the mesolimbic pathway = drug-induced psychosis

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10
Q

Where does the mesocortical pathway run?

A

From the ventral tegmental area to the prefrontal cortex

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11
Q

What is the mesocortical pathway responsible for?

A

Cognition
Motivation
Social Engagement

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12
Q

How does psychosis affect the mesocortical system?

A

Makes it hypoactive = reduced stimulation to the prefrontal cortex = negative psychosis symptoms (cognitive impairment & social withdrawal)

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13
Q

What does the nigrostriatial system do?

A

Regulates basal ganglia (involved in initiation of movement)

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14
Q

How do antipsychotics affect the nigrostriatal system?

A

Cause impaired movement by interfering with the nigrostriatal pathway.

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15
Q

What does the tuberoinfinduibular system regulate?

A

The HPA axis - therefore control of endocrine system

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16
Q

How do antipsychotics affect the tuberoinfundibulnar system?

A

They can interfere in this pathway - causing hormonal problems in Ps.

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17
Q

What type of drug are antipsychotics?

A

They are postsynaptic dopamine antagonists

18
Q

What percentage of dopamine should antipsychotics block?

A

60-70%

19
Q

How do antipsychotics affect the mesolimbic system?

A

They suppress both pleasure & threat evaluation.

Cause dysphoria (loss of pleasure in life)

20
Q

What often leads Ps to abandon their antipsychotic medication?

A

Dysphoria (loss of pleasure in life)

21
Q

How do antipsychotics traditionally affect the mesocortical system?

A

Depress it further - worsening negative symptoms

22
Q

How do traditional antipsychotics affect psychosis?

A

They suppress dopamine - so they can lessen some of the positive symptoms (via suppression of mesolimbic system) but they can exacerbate the negative symptoms (via the mesocortical system)

23
Q

What is the difference between first and second generation antipsychotics?

A

First generation = were big dopamine blockers = lots of side effects (e.g. Parkinsons)

Second Generation = target other NTs such as serotonergic pathways

24
Q

What do first generation antipsychotics cause by inhibiting the nigrostriatal and tuberoinfundibulnar pathways?

A

Movement and hormone dysfunctions

25
Q

What side effects were reduced by second generation antipsychotics?

However - what side effects were reported instead?

A

Movement and hormonal side effects were reduced.

BUT

cardia-metabolic symptoms were reported instead (diabetes, weight gain & CVS disease)

26
Q

What are the differences between how first and second generation antipsychotics work?

A

First generation = dopamine antagonist - binds to the postsynaptic receptor and blocks 60-70 of dopaminergic receptors.

Second generation = still block 60-70% of dopaminergic receptors BUT have more dynamic “off-time” = reduced side effects.

ALSO - bind to 5HT2A receptor on presynaptic neuron = slows down the release of dopamine into the cleft

27
Q

Which second generation antipsychotic is the most effective?

A

Clozapine

28
Q

When do you use Clozapine?

A

Treatment-resistance illness

Therefore - when you’ve tried at least two other antipsychotics before being prescribed this

29
Q

What is the most important factor in determining recovery from psychosis?

A

Duration of untreated psychosis - the longer this psychosis persists untreated, the worse the outcomes are.

30
Q

Why do psychiatrists not prescribe clozapine earlier?

A

Because of its serious side effects

Apart from weight gain, CVS & diabetes problems - it can also cause neutropenia (low WBCs) & low granulocytes. Can be very problematic for Ps.

31
Q

Why should we use long-term antipsychotics?

A

Effectiveness in treating positive symptoms is proven & maintenance of P mental health is well established.

No good evidence that there is long-term harm from them - is no good evidence that there are brain changes from antipsychotic usage.

32
Q

What is the downside to long-term use of antipsychotics?

A

If dopamine receptors are continually blocked, sometimes cells respond by increasing the number of receptors

33
Q

When the nigrostriatal pathway is blocked - what type of side effects does it cause?

A

Extrapyramidal side effects

34
Q

What symptoms are included in extrapyramimdal side effects?

A

Acute dystonia (sharp muscle spasms in face and neck)

Akathisia (inner restlessness)

Parkinsonism (stiffness of movement)

Tardive dyskinesia (long-term abnormal movements of moths and lips)

35
Q

In what 3 ways do antipsychotics produce cardio metabolic side effects?

A

Affect hypothalamus = no satiety - Ps commonly overeat

Raise serum lipid & cholesterol levels

Affect glucose tolerance & impact on insulin = inc levels of T2 diabetes

36
Q

How do antipsychotics affect the heart? What should you do before and during their use?

A

Affects the QT interval of the heart

MUST give ECG before prescribing and monitor with ECGs

37
Q

On average how much earlier do Ps die when they have psychosis?

What do they usually die from?

A

15-20 years earlier

Usually from cardiovascular disease (but not necessarily because of antipsychotics side effects)

38
Q

Why is cardiovascular disease a common cause of death for Ps with mortality?

A

Because Ps dont look after themselves
Social factors can play a part
Side effects are not managed as well as they could be by doctors

39
Q

Does the amount of medication that you are on impact your mortality rates?

Why?

A

Compared to zero medication - you have lower mortality rates if you take moderate or high antipsychotics.

Although medication does have side effects (which can be harmful) - on the balance with improved mental health, Ps are more likely to visit GP, take other medications, engage in exercise and be happier and healthier

40
Q

Name three alternative treatments to antipsychotic meds for mental illness.

A

CBT (Cognitive Behavioural Therapy)

Arts Therapy

Family intervention

NSB Lectures (48 decks)

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