Antipsychotics

Question 1

mesolimbic system dopamine pathway as it relates to psychosis

Answer 1

• goes from tegmentum to nucleus accumbens
• gives you positive symptoms of schizophrenia
• block these D2 receptors–> no + symptoms

Question 2

mesocortical system: as it relates to psychosis

Answer 2

• goes from tegmentum to the frontal and limbic cortex
• mediates negative symptoms of schizophrenia
• blocking only D2 here leads to worse negative symptoms (5HT levels go up, might explain why)
• this explains why blocking only D2 isn’t a good treatment

Question 3

Nigrostriatal pathway

Answer 3

• goes from substantia nigra to basal nuclei (AKA basal ganglia. In this case, the striatum (caudate and putamen) are involved)
• using anti psychosis drugs that block D2 work here and cause the parkinson’s side effects

Question 4

Tuberoinfundibular pathway

Answer 4

• runs form the hypothalamus to the pituitary
• DA inhibits prolactin in this pathway
• leads to gallactorrhea, amenorrhea, sexual dysfunction

Question 5

First generation antipsychotics: names

Answer 5

chlorpromazine
haloperidol
Thioridazine
Fluphenazine

Question 6

First generation antipsychotics: effectiveness, mechanism

Answer 6

• Good against positive symptoms

- Block D2 receptors everywhere in brain

Question 7

Positive symptoms of schizophrenia

Answer 7

Delusions
Disorganized Speech
Grossly Disorganized Behavior
Catatonic
Hallucinations (auditory)

Question 8

Negative symptoms of schizophrenia

Answer 8

Lack of emotion/interest in life
Social Isolation
Affective Flattening (blank facial expression)
Alogia (difficulty speaking)
Inability to Keep Friends

Question 9

Second generation antipsychotics: names

Answer 9

Clozapine
*Risperidone* (she loves this one)
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole

Question 10

Second generation antipsychotics: Mechanism, side effects, ethics

Answer 10

Block D2 receptors AND 5-HT receptors
Weight gain, increase chance of type 2 diabetes
Life threatening adverse effect (Agranulocytosis)
ethics->can someone with schizo really understand side effects that lead to death (informed consent?)

Question 11

Why no parkinson’s side effects with 2nd gen drugs

Answer 11

Blocks 5-HT which seems to balance out the blocking of D2

blocking D2 lowers activity, lower 5-HT balances it out

Question 12

Tardive Dyskinesia

Answer 12

DA Receptor Disuse Supersensitivity
parkinson’s symptoms that don’t go away after drug is stopped–> may take years to go away, may never go away
1st gen–>5% get it (53% of elderly)
2nd gen–>1% get it( 5% of elderly)