Anti-Psychotics

Question 1

Psychosis

Answer 1

broad group of thought (as opposed to mood disorders)

Question 2

Mania

Answer 2

abnormally, persistently elevated expansive or irritable mood with increased activity and energy

Question 3

Schizophrenia

Answer 3

prototype psychotic disorder characterized by abnormal behavior, inability to think coherently, and comprehend reality and limited illness insight

Question 4

Bipolar disorder

Answer 4

mood disorder characterized by episodes of mania or hypomania intespersed with episodes of major depression

Question 5

Schizoaffective disorder

Answer 5

mental disorder with features of schizophrenia and a mood disorder

Question 6

Neuroleptic

Answer 6

major tranquilizers, outdated, first generation anti-psychotics

Question 7

Positive symptoms

Answer 7

beyond what is considered normal cognition (delusions), perception (auditory hallucinations) and affect
usually respond well to meds
ex: delusions, thoughts, disturbances, inappropriate affect, altered motor function

Question 8

Negative symptoms

Answer 8

deficit of normal emotional responses
do not respond well to meds
ex: poverty of speech and thought, loss of emotion, lack of spontaneity and motivation, social isolation

Question 9

Cognitive dysfunction

Answer 9

best predictor of poor functional outcomes

Question 10

Dopamine hypothesis of Schizophrenia

Answer 10

1. Excess mesolimbic dopamine (positive symptoms) = neuroleptics block D2 receptors in CNS or deplete dopamine from nerve terminal
2. Deficit of mesocortical dopamine (negative symptoms) - neuroleptics make worse

Question 11

Mesolimbic-mesocortical

Answer 11

emotional and cognitive circuitry
learning and memory
D2 antagonist target

Question 12

Nigostratal

Answer 12

Movement
Parkinson = degeneration
related to mesolimbic, if mesolimbic decreases, then parkinsonian symptoms develop

Question 13

Tuberoinfundibular

Answer 13

prolactin secretion -> hyperprolactinemia
increase DA = inhibition of prolactin
-> inhibit DA = increase prolactin
= weight gain and sexual dysfunction

Question 14

Medullary-periventricular

Answer 14

eating behavior

DA antagonist = anti-emetic

Question 15

Typical antipsychotics

Answer 15

First generation
used for (+) symptoms, more side effects
associated with extrapyramidal side effects (EPSE) and tardive dyskinesia (TD)
high affinity for D2 receptor and block 
very cheap and still used

Question 16

Atypical antipsychotics

Answer 16

Second generation
used for (+) & (-) symptoms and cognitive dysfunction
less side effects
associated with lower risk of EPSE/TD but HIGHER risk of weight gain and adverse metabolic effects

Question 17

Typical mechanism

Answer 17

Dopamine D2 receptor antagonists

>60% receptor occupancy

Question 18

Atypical mechanism

Answer 18

affinity for 5HT2A (Serotonin) is greater than D2

allows to treat negative symptoms and decreased EPSE

Question 19

Pharmacokinetics for anti-psychotics

Answer 19

Highly lipophilic, orally or parenteral
Onset is rapid
Long half life (20-40 hours)
Extensive metabolism (CYP2D6)

Question 20

EPSE symptoms w/ 80% receptor occupancy

Answer 20

Akathisia - restlessness
Parkinsonism - tremor, shuffling gait,
Dystonias - muscle spasm
Tardive dyskinesia - chronic use, oral facial dystonia

Question 21

Neuroleptic malignant syndrome

Answer 21

Rare, life-threatening
Tetrad: AMS, hyperthermia, extreme muscle rigidity, autonomic dysfunction
Require drug withdrawal

Question 22

Haloperidol (Haldol)

Answer 22

Prototype first generation
Higher risk, less sedating
1st drug for schizophrenia, tourettes tics, behavioral problems in children
ICU delirium, OCD, sedation of agitated patients

Question 23

Chlorpromazine

Answer 23

Low potency
Low risk of EPSE, more sedating
tx: psychosis, N/V, severe behavioral problems in children, dementia behavior

Question 24

Clozapine

Answer 24

UNIQUE - good for negative s/s
Recalcitrant schizophrenia & suicidal behavior w/ schizoaffective patients
Risk of agranulocytosis* - lethal! = last resort if other antipsychotics haven’t worked
no risk of EPSE

Question 25

Risperidone, Olanzapine, Quetiapine, Ziprasidone

Answer 25

5-HT2A > D2 antagonists

Question 26

Aripiprazole (Abilify)

Answer 26

Partial D2 receptor agonist (25%)

block full agonist effect of dopamine and 5-HT2A

Question 27

Monotherapy

Answer 27

use one atypical 4-6 weeks

Risperidone, Olanzapine, Quetiapine, Ziprasidone - all are the same efficacy