7. Antipsychotics & Bipolar Flashcards
When does the onset of schizophrenia occur in each gender?
Which gender if affected more?
Males 15-24
Females 25-34
Males have 1.4x the risk
What are the positive sx of schizophrenia?
Hallucinations
Delusions
Disorganized speech
What are the negative sx of schizophrenia?
Avolition (lack of drive, motivation)
Alogia (poverty of speech)
Anhedonia (inability to feel pleasure)
Blunted affect (reduced emotional responses)
Describe the cognitive sx associated with schizophrenia.
- declined attention, language, memory, executive function.
- probably present from birth
Describe the affective sx associated with schizophrenia.
- blunted, inappropriate, odd expression
- often leads to social stigmatization
How are the positive and negative sx related to dopamine levels?
- too much mesolimbic dopamine leads to positive sx
- low mesocortical dopamine leads to negative sx
What are the effects of dopamine on the nucleus accumbens?
- motivation
- reward
- addiction
- reinforcing behavior
What are the effects of dopamine on the prefrontal cortex?
- cognition
- communication
- social function
- stress response
Which receptors due most antipsychotics strongly block?
D2 dopamine receptors
What is the mechanism of action for typical antipsychotics?
It is antagonism of D2 receptors in the mesolimbic pathway.
This causes relief from positive sx
What are the adverse effects of typical antipsychotics related to?
- receptor non-selectivity
2. block of non-mesolimbic D2 dopaminergic pathways
With respect to receptor non-selectivity, what side effects are due to the antimuscarinic effects?
- toxic confused state
- dry mouth
- urinary retention
With respect to receptor non-selectivity, what side effects are due to the blocked alpha-1 adrenergic effects?
- orthostatic hypotension
- dizziness
- tachycardia
- impotence
With respect to receptor non-selectivity, what side effects are due to the histamine H1 blockade?
- weight gain
- sedation
When you block D2 receptors in the ___________ pathway, this can cause extrapyramidal side effects (EPS). What are some examples?
Nigrostriatal
- Parkinson’s
- akathisia (state of agitation, distress, restlessness)
- acute dystonic reactions (muscles contract uncontrollably)
- tardive dyskinesia (involuntary face and jaw movement)
Why should antipsychotics and anticholinergics drugs not be given together?
Because antipsychotics already cause anticholinergic effects.
If given together, the effects will add together.
When you block D2 receptors in the ___________ pathway , there will be an increase in prolactin production. What are the side effects of this in males and females?
Tuberoinfundibular
Males:
- lactation
- impotence
- decreased libido
- gynecomastia
Females:
- lactation
- amenorrhea
- infertility
What are some other side effects of antipsychotics?
- pseudodepression (related to drowsiness, restlessness and autonomic effects)
- corneal and lens deposits
- retinal deposits
- cardiac arrhythmias in OD
- neuroleptic malignant syndrome
What is neuroleptic malignant syndrome? (antipsychotic SE)
- severe muscle rigidity
- impaired sweating
- fever
- autonomic instability
- severe agitation
What are the advantages of atypical antipsychotics?
- they block D2 in the NAcc which decreases positive sx
BUT ALSO: - have reduced D2 affinity (lower EPS)
- block serotonin receptors –> decreases negative sx
How does increased serotonin affinity in atypical antipsychotics help reduce negative sx?
When serotonin receptors are blocked, mesocortical dopamine will be increased.
This will decrease the negative sx
What are the side effects of atypical antipsychotics?
- same as typical, but lower risk (esp. with EPS)
- seizures
- weight gain, hyperlipidemia, hyperglycemia (due to 5HT block)
- agranulocytosis
- higher death rate in elderly dementia pts
Which atypical antipsychotics has a large risk of seizures?
Clozapine
What substances will cause a decrease in metabolism of CYP 3A4?
fluoxetine
grapefruit juice
