Antipsychotics

Question 1

What is psychosis?

Answer 1

Different perception of reality from most people; chiefly observed by hallucinations, delusions, confused thoughts

Question 2

What may be the causes of psychosis?

Answer 2

Schizophrenia (most common)
                   Bipolar disorder
                   Neurodegenerative diseases
                   Severe depression
                   Severe stress
                   Sleep deprivation
                   Alcohol & drug abuse

Question 3

“Positive” symptoms of schizophrenia

Answer 3

Delusions (often paranoid)
Hallucinations (often “hearing voices”)
Thought disorder (e.g. rambling speech)
Abnormal and disorganised behaviour
Catatonia (immobility, purposeless movement)

Question 4

“Negative “ symptoms of schizophrenia

Answer 4

Social withdrawal
Low emotional responses
Inability to experience pleasure
Reluctance to perform tasks

Question 5

What are the cognitive deficits of schizophrenia?

Answer 5

Poor memore

Low attention span

Question 6

In the dopamine theory of schizophrenia, “positive symptoms “ are due to

Answer 6

Mesolimbic pathway: Dopamine overactive

D2 receptors predominate

Question 7

In the dopamine theory of schizophrenia, the “ negative” symptoms are due to?

Answer 7

Mesocortical pathway: Dopamine underactive

D1 receptors predominate

Question 8

Antipsychotics can be classified into

Answer 8

“First generation” or “typical” antipsychotics

“Second generation” or “atypical” antipsychotics

Question 9

What is the major problem with antipsychotics

Answer 9

Compliance

Question 10

Antipsychotics overdose effects?

Answer 10

sedation if mild

cardiotoxicity and seizure risk if severe

Question 11

Extrapyramidal effects (EPS) of antipsychotics

Answer 11

Acute dystonia

Tardive dyskinesias

Question 12

Endocrine effects of antipsychotics

Answer 12

↑ prolactin; breast swelling, pain,

lactation (also affects males)

Question 13

Other side effects of antipsychotics

Answer 13

Sedation (Histamine H1 receptors, mAChR, a1)
•Weight gain (H1, 5-HT, mAChR)
•Hypotension (a adrenoreceptors)
•Anticholinergic effects e.g. dry mouth, blurred vision (mAChR)
•Sexual dysfunction (all receptors)

Question 14

What is acute dystonia

Answer 14

Involuntary movements, muscle twitching

• Can be ameliorated by antimuscarinics and 5-HT1A receptor antagonists
• Reversible upon cessation of treatment of antipsychotics
• Later development of Parkinsonian symptoms, and then akathisia
• Neuroleptic malignant syndrome: hyperthermia, confusion, tachycardia.

Question 15

What is tardive dyskinesia?

Answer 15

Upregulation & sensitisation of D2 receptors

• Involuntary movements of face, trunk & limbs; potentially disabling. Affects 20-40% of patients.
• Develop after months to years of treatment, especially with first generation drugs.
• May get worse after treatment cessation- often irreversible

Question 16

All antipsychotics have cautions with cardiac dysfunction & risk of sudden death . True or false

Cause?

Answer 16

True

Inhibition of some cardiac K+ channels: torsade de points

Question 17

What is the most commonly used 1st gen antipsychotics drug

Answer 17

Chlorpromazine

Question 18

Haloperidol

Answer 18

1st gen antipsychotics drug
Rarely prescribed for long-term use (high EPS) Usually for treatment of acute delirium (IV), also nausea.

Question 19

Chlorpromazine side effect

Answer 19

Notable side effect of jaundice, lower EPS than many other 1st gen antipsychotics

Question 20

Zuclopenthixol

Answer 20

1st gen antipsychotics drug

Non-selective D1 / D2 antagonists. Available as depot preparation

Question 21

What is the 2nd gen antipsychotics drug ?highly recommended antipsychotics drug used for treatment resistant with antipsychotics

Answer 21

Clozapine

Question 22

Quietiapine & Olanzapine

Answer 22

2nd gen antipsychotics drug

Most prescribed. Olanzapine more efficacious than quetiapine, but worse motor side effects.

Question 23

What is the First “2nd generation” antipsychotic, although discovered early (1958)

• Often effective in otherwise treatment-resistant patients
• Now rarely prescribed; serious side effect of agranulocytosis; sudden death (often myocarditis)
• Lack of EPS = useful for Parkinson’s Disease psychosis

Answer 23

Clozapine

Question 24

Which 2nd gen antipsychotics drug is available as depot preparation; medium EPS?

Answer 24

Risperidone

Question 25

Which 2nd gen antipsychotics drug is partial agonist at D2; lower DAergic side effects
moderate efficacy, relatively well tolerated?

Answer 25

Aripripazole

Question 26

What is the first line treatment for schizophrenia?

Answer 26

2nd generation antipsychotics - less adverse effect

Question 27

What is the wind June treatment for schizophrenia?

Answer 27

1st generation antipsychotics, chiefly chlorpromazine and related compounds