Anti-psychotics

Question 1

What is schizophrenia and how is it charecterized?

Answer 1

A psychotic disorder that at a miniumum consitists of dellusions and hallucinations

Charecterised by distortions of thinking and perception. It affects the emotionial response to stimuli/situations, becoming inapproprite or blunted

Question 2

What are the 5 diensions of symptoms shown by Schizophrenic sufferers?

Answer 2

Posititve symptoms

Negitive symptoms

Cognitive symptoms

Agressive symptoms

Depression and anxiety

Question 3

What is required for a diagnosis of Schizophrenia to be reached?

Answer 3

Disturbance lasting for 6 months or longer with at least one of the classical symptoms, delusions, hallucinations, disorganised or catatonic behavior or negitive symptoms

Question 4

Name 5 classical symptoms of Schizophrenia

Answer 4

Thought echo/instertion/withdrawal

Delusional perception and control

Hallucinatory voices that comment or discuss the patient in the third person

Though disorders

Influence or passivity

Question 5

Give 4 ‘negitive’ symptoms of Schozophrenia

Answer 5

Affective blunting = reduced emotional reactivity

Ahedonia = loss of enjoyment or intrest in previously enjoyed activites

Alogia = Loss of the ability to speak

Apathy = Absence or supression of emotion feeling, concern or passion

Question 6

Give 5 positive symptoms of Schizophrenia

Answer 6

Delusions

Hallucinations

Agitation

Exaggerated/disorganised speech

Exaggerated/disorganised bizzare behavior

Question 7

What anatomical alreations can be see in Schizophrenia?

Answer 7

Imbalance in transmitter levels are thought to underpin schizophrena (dopamine)

Degeneration occurs within the grey matter - particularly within the medial temporal lobes

Enlarged ventricles and sulci are apparent on scanning as a result

Cerebral blood flow is reduced in the basal ganglia and frontal lobes

Question 8

What is the target for antipsycotics?

Answer 8

Dopamine receptors

Dopamine antagonists have been proven to calm Schizophrenic patients

Question 9

What is the major problem with antipsychotics?

Answer 9

Less effect on negitive symptoms

60% of patients still suffer these even when the negitive symptoms are under control

Question 10

What are the two groups of antipsychotics?

Answer 10

First generation - Classical

Second generation - Atypical

Question 11

What receptors do first generation antipsychotics act on?

Answer 11

Primarily potent antagonists at the D2 receptor

Also act on Muscaranic, Histamine, and Adrengic receptors

Low efficacy and 30% of patients are non-responders

Question 12

What are the 4 main groups of first generation antipsychotics?

Answer 12

Phenothiazines

Butyrophenones

Thioxanthines

Dibenzoiazenes

Question 13

Second generation antipsychotics were initially delveloped to around 5HT and dopamine antagonism, however they have been found to act on other receptors. What are these receptors?

Answer 13

Multiple receptor subtypes of 5HT and Dopamine

Muscarinic, histminergic and aderenergic receptors

May also inhibit reuptake mechanisms

Question 14

What is the gold standard second generation Antipsychotic?

Answer 14

Clozapine

High efficancy but has the most associated side effects (cardiovascular)

Also causes Agranulocytosis

Generally only used after at least 2 second generation antipsychotics have been shown to be ineffective

Question 15

Which two second generation antipsychotic drugs are the most effective at tacking negitive symptoms?

Answer 15

Risperidone and Olanzapine

Question 16

Risaperidone can be classed as both a first and second generation antipsychotic. Why is this?

What other uses/benfits does this drug have?

Answer 16

Shows biphasic activity. Atypical at low doses and more conventional at higher doses.

Used to treat dementia

Can be used in children and adolescents

Question 17

Name first (2), second (3) and third generation (1) antipsychotics

Answer 17

1st = Chlorpromazine, Haloperidol

2nd = Amisulpride, Risperidone, Clozapine

3rd = Aripiprazole

Question 18

What are the majority of side effects seen with antipsychotics called?

What are they a result of?

Answer 18

Extrapyramidal symptoms

As a result of altering activity within the nigrostrital pathway

Question 19

Give examples of 3 extrapyramidal symptoms caused as a side effect of antipsychotics

Answer 19

Dystonias

Akathisia

Parkinsonisms

Question 20

What are the side effects of antipsychotics?

Answer 20

Extrapyramidal symptoms

Sedation

Seizures

Hypotension

Hypothermia

Hypersensitvity

Weight gain

Question 21

Why are second generation antipsychotics associated with seeing reduced side effects?

Answer 21

2nd generation antipsychotics have a higher affinity for the mesolimbic and cortical pathways than the nigrostriatal dopaminergic pathways.

Question 22

What is neuroleptic malignant syndrome?

Answer 22

Describes the side effects associated with the use of antipsychotics in patients with a genetic polymorphism of the D2 receptor

High fever, autonomic problems, and altered consciousness

Question 23

Where a patient presents with neuroleptic malignant syndrome, how can the side effects caused by the use of antipsychotics be treated?

Answer 23

Dopamine agonists and benzodiazepines can be used following immedate withdrawal of the antipsychotic

Question 24

What is Tardive dyskinesia?

Answer 24

Disabling invoulentary movements of the face and limbs: tounge protruding, grimacing and twisting of the face and limbs

Only side effect that is irrevesible - spontanelously remitts in 30% of presentations

Question 25

What causes Tardive dyskinesia?

Answer 25

A result of oxidative neurodegneration caused by increased glutamatergic transmission wich results from a down-regulation of the dopamine system

Caused by prolonged use of classical antipsychotics

Question 26

What would be the action you would take on presentation of Tardive dyskinesia?

Answer 26

Withdraw the classical antipsychotic

Switch to a atypical antipsychotic

Immediately stop any anticholinergics being used

Question 27

What dopamine pathway is involved in the pathogenesis of schizophrenia?

Answer 27

Mesolimbic and Mesocortical

Question 28

Which of the dopamine pathways are used in parkinsonism?

Answer 28

Striatongral

Question 29

What substances can induce iatrogenic parkinsonism?

Answer 29

Antiemetics

Antiepileptics

Cardiovascular agents

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