2. Neuroleptics (psychosis)

Question 1

What is neurosis?

Answer 1

Neurosis- class of functional mental disorders involving distress with neither delusions nor hallucinations (behaviour not outside socially acceptable norms)
Can unlearn these (seek therapy)

Psychosis- more severe forms of psychiatric disorders
Hallucinations, delusions, impaired insight may occur
Loss of contact with reality
Disruption of brain function
Problem with neurochemistry (neurodegeneration in different areas too)

Question 2

What are the typical antipsychotics?

In order of increasing potency

Answer 2

Haloperidol (1mg potency)
Zuclopenthixol (4mg potency)
Chlorpromazine (100mg potency)

Question 3

What are the atypical antipsychotics?

In order of increasing potency

Answer 3

Quetiapine (low potency)
Clozapine
Olanzapine
Risperidone (high)

Slide 13

Question 4

What is atypical and typical in antipsychotics?

Answer 4

Typical- first generation (not first line anymore, used because of family history
Just D2 blockade, causes imbalance between dopamine and ACh which gives Parkinson’s like symptoms

Atypical- second generation
Likely the first line
Less potent than the typical drugs
Extrapyramidal side effects less common with atypical (why they are first line)
Atypical has D2 block (dopamine) and 5-HT block (serotonin)
Atypical have been linked to weight gain, hyperglycaemia, lipid abnormalities

Slide 8

Question 5

What are positive and negative symptoms in describing mental disorders such as schizophrenia?

Answer 5

Positive symptoms- most people do not experience these but they are present in the disorder
Excess or distortion of normal functions (experiences behaviours that have been added to a persons normal way of functioning)

Negative symptoms- symptoms that are not present our diminished in the affected persons but are normally found in healthy people
Reflects diminution or loss of normal functions

Question 6

What is the dopamine hypothesis of Schizophrenia?

Which symptoms do dopamine treatments reduce?

Answer 6

Anti-schizophrenia drugs are dopamine D2 antagonists (too much dopamine in schizophrenia)
Dopamine receptor over stimulation mimics schizophrenia (opposite of Parkinson’s- not enough dopamine)
Amphetamine induces psychosis (psychosis is an adverse effect of Parkinson’s treatment)

Dopamine antagonists reduce positive symptoms of schizophrenia, not negative

VTA= Ventral tegmental area

Slide 6

Question 7

What are the steps to using antipsychotics?

Combining, atypical vs typical, etc

Answer 7

No reason to combine antipyschotics (all are equally effective)
Atypical are as effective as typical but atypical have better side effects
Choose drug that patient has responded to in the past or family member used

Intramuscular injection not used for life, used for people picked up by the police or something

Slide 7

Question 8

What are the 6 extrapyramidal motor symptoms (EPS)?

Answer 8

1. Acute dystonia- spasm of tongue, face, neck, back muscles (1-5day)
   Treat with benzotropine
2. Akathisia- inability to remain motionless (very distressing) (5-60day)
   Treat by changing drug or dose
3. Pseudoparkinsonism- bradykinesia, rigidity, variable tremor, shuffling gait (5-30day)
   Treat with benztropine
4. Perioral tremor- rabbit like movements of mouth and face (months)
5. Neuroleptic malignant syndrome (NMS)- massive dopamine block leads to fever, muscle rigidity, unstable blood pressure, lactic acidosis, shock and dehydration
   Treat by stopping drug, hydrate, cool
6. Tardive dyskinesia- repetitive, painless, involuntary, tic-like movements of face, eyelids, mouth, tongue, extremities

Slides 15-16

Question 9

Compare Parkinson’s and Psychosis?

Answer 9

Parkinson’s- loss of dopamine in basal ganglia in substantia nigra
Want to increase dopamine to treat

Psychosis- VTA (projects frontal cortex) has an increase dopamine
Want to decrease dopamine to treat

Question 10

Read case study slide 17

Answer 10

Ok