Chapter 16: Drugs for Psychoses Flashcards
What is Neurosis?
Neurosis is a class of functional mental disorders involving distress with neither delusions nor hallucinations, wherby behaviour is not oustide socially acceptable norms.
Maladaptive learned behavior.
What is Psychosis?
- Psychosis is given to the more sever forms of psychiatric disorders, during which hallucinations, delusions and impaired insight may occur.
- Loss of Contact with reality and Disruption of Brain function.
- Neurochemical Imbalance
What can cause the neurcochemical imbalance in psychosis?
- Drugs/Chemicals
- Neurodegeneration
- Genetic and environmental factors including neurodevelopmental abnormalities.
In regards to antipsychotic drugs,
What does Atypical Mean?
Atypical means substanially lower risk of Extra Pyramidal Side effects.
What 3 categories can symptoms of mental disorders be divided into?
- Alterations in cognitive control
- Positive Symptoms
- Negative Symptoms
What are Positive Symptoms?
Symptoms that most indiviuals do not normally experience but are present in the disorder. It reflects an excess or distortion or normal functions (experiences and behaviours that have been added to a person’s normal way of functioning.)
Important Characteristics: Easy to tell, Hallucinations fall in this category, Linked to Dopamine.
What are negative symptoms?
Symptoms that are not present or that are diminished in the affected persons but are normally found in healthy people. It reflects a diminution or loss of normal functions
( something that has been taken away from a person’s normal way of functioning)
Important Characteristics: Linked to serotonin, does not involve hallucinations, diminshed emotions in this category.
What are alterations in cognitive control?
Lack of ability to adjust thoughts and behaviors to achieve goals.
What is the Dopamine Hypothesis of Schizophrenia?
DA receptor over-stimulation mimics Schizophrenia
What type/mechanism of drugs are anti-schizophrenia drugs?
Dopamine D2 Antagonists
What type of symptoms to DA Antagonists help?
Reduce Positive Symptoms but not the negative symptoms of Schizophrenia.
What is Amphetamine Pyschosis caused by?
Cocaine-induced psychosis and amphetamine psychosis share similarities in their impact on the brain’s norepinephrine (NE) system. Cocaine increases NE levels by blocking its reuptake at synapses, resulting in heightened arousal, vigilance, and anxiety, which can contribute to paranoid delusions and psychotic symptoms. Amphetamines also elevate NE by stimulating its release and inhibiting reuptake, leading to a similar but often more prolonged overstimulation of the sympathetic nervous system. This NE dysregulation amplifies the hypervigilance and paranoia seen in psychosis. The heightened NE activity, combined with excessive dopamine signaling, creates a neurochemical environment conducive to psychotic states in users of both drugs.
What is adverse effect of therapy in Parkinson’s Disease?
Psychosis
What are the Rational uses for antipsychotics?
What are the long acting preparations of Antipsychotics?
What are the 2 typical Antipsychotics?
- Haloperidol (High Potency)
- Chlorpromazine (Low-Potency)
What are characteristics of Typical Antipsychotics?
- 70-75% block of Postsynaptic D2 receptors.
- Only affects positive symptoms
- Causes EPS side affects.
What is the mechanism and side effects of Haloperidol?
- Blocks d1 and d2 dopamine receptors.
- Has Dopamine related side effects - Extrapyramidal symptoms, hyperprolactinemia anti-emetic, tardive dyskinesia.
High Potency
What is the mechanism and the side effects of Chlorpromazine?
Low Potency
- DA Antagonist, Weak Andregenic Antagonist, Muscarinic Antagonist, Histamine Antagonist.
Side Effects
- Andrgenic side effects: Postural Hypotension
- Muscarinic Side effects: Constipation, sedation, hypotension, anxiolytic.
- Histamine side effects: Sedation, itching
In some countries, such as the USA, injections of ____ such as ____ can be ordered by a ____ at the request of a ____.
In some countries, such as the USA, injections of antipsychotics such as Haloperidol can be ordered by a court at the request of a psychiatrist.
What are the characteristics of Atypical Antipsychotics?
- 50-60% Block of Postsynaptic D2 Receptors
- 75-95% Block of 5HT2A Serotonic Receptors
- Treats Positive and Negative Symptoms
Given These Properties,
What drug is this?
Clozapine (Clozaril)
Given these properties,
What drug is this?
Risperidone (Risperdal)
Given these properties,
What drug is this?
Olanzapine (Zyprexa)
Given these properties,
What drug is this?
Quetiapine (Seroquel)
Given these properties
What drug is this?
Aripiprazole (Abilify)
Given these properties,
What drug is this?
Pimavanserin (Nuplazid)
Explain the risk of atypical antipsychotics with weight gain and explain which atypical drugs are better than the others in regards to this.
Atypical antipsychotics have been linked to weight gain, hyperglycemia, and lipid abnormailites and are associated with an increased risk of metabolic syndrome.
Risk of weight gain: Clozapine/Olanzapine > Resperidone/Quetiapine
What are the Atypical Antipsychotic drugs?
- Clozapine
- Risperidone
- Olanzapine
- Quetiapine
- aripiprazole
- Pimavanserin
If there are alot of side effects from blocking DA with antipsychotics - what can we use to relieve side effects?
Need Da and Ach back in balance - do not want to alter DA levels otherwise could be reversing antipsychotic treatment.
Can use Trihexyphenidyl or Benzotropine to rebalance.
What are all the different EPS you can get with Antipsychotics and how do you treat?
- Acute Dystonia - Spasm of tongue. face. neck and back muscles - Treat with Benztropine
- Akathisia - Inability to remain motionless - Change drug or dose (Lower Potency)
- Pseudoparkinsonism - Bradykinesia, rigidity, variable tremor, shuffling gait. - Benzotropine
- Perioral Temor - Rabbit like movements of mouth and face
- Neuroleptic Malignant Syndrome NMS - Massive DA Block; Muscle rigidity, fever, unstable blood pressure, lactic acidosis, shock and dehydration; 5% Mortality - Stop drug, hydrate, cool, dantrolene and Bromocriptine
- Tardive Dyskinesia - Repetitive, painless involuntary tick movements of face, eyelids, mouth, extremities. - Appears after long term of high dose use of Antipsychotics.
How does Dantrolene and Bromocriptine help NMS?
Dantrolene - Inhbit Ca release in Muscles helping muscle rigidity and helps stabilize Blood Pressure.
Bromocriptine - Dopamine Agonist
What are the First Line Atypical Antipsychotics?
Resperidone, Olanzapine and quetiapine.
NO differences in efficacy, speed and stabiity; Disadvantage = cost
