Antipsychotics

Question 1

Four positive symptoms of psychosis

Answer 1

Anhedonia, hallucinations, bizarre behaviour, disorganised thoughts/incomprehensible speech

Question 2

Five negative symptoms of psychosis

Answer 2

Amotivation, anhedonia, “stuntedness”, poverty of speech, asociality,

Question 3

Why do we suspect a genetic influence on psychosis risk?

Answer 3

1st degree relatives: 10% chance

identical twins: 50% chance.

Question 4

The dopamine theory is strengthened by the effectiveness of D2 receptor antagonists. What conversely supports the theory?

Answer 4

D2 agonists like apomorphine or amphetamines or levodopa bring symptoms on.

Question 5

You start a young male on a first gen antipsychotic. What do you tell him about his chances of responding vs. trying something else?

Answer 5

About 30% of people don’t respond to 1st gen antipsychotics.

Question 6

What do 1st gen antipschotics famously NOT do?

Answer 6

Help negative symptoms.

Question 7

What other theories cover aspects of psychosis?

Answer 7

Glutamate theory (psychosis = not enough glutamate)
Seratonin hypothesis (psychosis = too much seratonin)

Question 8

What do the 1st gens end in?

That older toy is the dol you do operations on. 1st gen’s are nastier, they’re like a xena of antipsychotics. Lucky I’m typing because my pen ink can get to thick and I can’t pour out my soul.

Answer 8

• azine
• operidol
• penthixol

Question 9

What do the first gen drugs end in?

Answer 9

azine
operidol
penthixol

Question 10

What are the seven 2nd gen antipsychotics .

Keeps you quite. I’m gonna sulk at the parade. Say “the president” in a French accent.

Answer 10

clozapine, aripiprazole, respiradone, olanzapine,

ziprazadone, amisulparide, quetiapine

Question 11

What are the seven second gen antipsychotics

Answer 11

clozapine, olanzapine, respiridol, aripiprazole, quetiapine, zipresadone, imasulpiride

Question 12

What makes second gen better? Four things (one’s just a feature)

Answer 12

efficacy for resistant patients
efficacy against negative symptoms
fewer extrapyramidal side effects (and prolactin secretion)
different receptor affinity profile

Question 13

Four blockades characteristic of antipsychotics in general (one’s not under a blockade heading though)

Answer 13

Alpha
histamine
5HT
antimuscarinic (atropine-like)

Question 14

What are the associated side effects of: 
antimuscarinic
alpha blockade
histamine blockade
seratonin blockade

Answer 14

blurred vision, dry mouth, constipation, urinary retention
postural hypertension (peripheral hypotension)
sedation
weight gain

Question 15

Which of the blockade-heading side effects show tolerance after a short while.

Answer 15

sedative

hypotension

Question 16

Dopamine inhibits _______ in the _________ system, preventing lactation.

Answer 16

prolactin secretion; TUBEROFUNDIBULAR

Question 17

What are the four idiosyncratic reactions to antipsychotics

Answer 17

jaundice and blood stuff, antipsychotic malignant syndrome, urticaria

bonus: blood stuff is leukocytopaenia and agranulocytosis

Question 18

what is antipsychotic malignant syndrome?

Answer 18

an idiosyncratic side effect of antipsychotics.

Bonus: stiff muscles mixed with hypertension and confusion.

Question 19

ANTIPSYCHOTICS: what are the two brain structures you MUST remember?
Bonus: what’s the lactation one?

Answer 19

mesolimbic (antipsychotic effects)
substantia nigra (extrapyramidal effects)

tuberofundibular (lactation)

Question 20

Where are the antipsychotic effects created in the brain?

Answer 20

mesolimbic

Question 21

where are the extrapyramidal side effects created in the brain?

Answer 21

nigrostriatal pathway

Question 22

What is the significance of the mesolimbic system in antipsychotic therapy?

Answer 22

That’s where the antipsychotic dopamine reduction occurs.

Question 23

What is benztropine and why might you give it alongside an antipsychotic?

Answer 23

It’s an anticholinergic - helps restore some ACh/DA balance in the striatum and reduce extrapyramidal effects.

Question 24

2nd gen have higher affinities for ACh receptors. What’s the advantage here?

Answer 24

Lower extrapyramidal effects.

Question 25

What are the early EPSs antipsychotics? Tell me in order of appearance after dosing:
hours-days
weeks

Answer 25

acute dystonias - postural and facial spasms
laryngeal spasm can be life threatening
akithisia - almost restless leg syndrome

Question 26

Which suptype of EPS can be life threatening?

Answer 26

laryngeal spasming in acute dystonia

Question 27

What is the long term mega EPS?

When do we expect it to usually occur?

Answer 27

TARDIVE DYSKINESIA
Darting limbs and mega mouth/jaw spasms.

Often precipitates on discontinuation.
Because of upregulated D2 receptors and chronic [inhibitory] D1 block.

Question 28

What’s behind the tardive diskinesia?

Answer 28

“disuse supersensitivity”

Question 29

Why would more rapidly dissociating drugs have lower EPS?

Answer 29

More accommodating of brief surges of DA (e.g. in the striatum).

Question 30

Which 2nd gen is also a partial D2 agonist?

Answer 30

Aripiprazole.

Partial agonism in the mesocortical pathway helps prevent negative symptoms and in the striatum it helps prevent EPS.