Clinical- Psychotic Disorders II Flashcards
What are the 4 dopamine pathways?
An increase of dopamine causes positive/negative symptoms in schizophrenia?
positive
Which of the 4 dopamine pathways goes from the VTA to the nucleus accumbens and concerning schizophrenia -an increase in dopamine causes positive symptoms?
mesolimbic pathway
Which 2 of the 4 dopamine pathways are mostly related to schizophrenia?
mesolimbic and mesocortical
Which schizophrenia related dopamine pathway involves dopamine hypoactivity which can cause negative, cognitive, and affectives symptoms?
mesocortical
Dopamine hyper/hypo activity can cause negative, cognitive, and affective symptoms?
hypoactivity
Which dopamine pathway travels from the substantia nigra to the striatum and can be affected by drugs in a way that produces extrapyramidial symptoms (EPS) and tardive dyskinesia as side effects?
nigrostriatal
What are the side effects to drugs (antipsychotics) affect the tuberohypophyseal domapine pathway?
hyperprolactinemia
hyperprolactinemia from drugs that inhibit D2 receptors in the tuberhypophyseal pathway can lead to what two symptoms ?
gynecomastia and lactation
What is the duration of time difference to separate brief psychotic disorder, schizophreniform, and schizophrenia?
Along with symptoms lasting less than a month, what is the other critera that must be met for brief psychotic disorder?
At least one Criterion A for Brief Psychotic Disorder
How many crietria for schizophreniform must be met along with a duration of 1 to 6 months?
2
Which disorder is being described of the primary psychiatric disorders?
A. An uninterrupted period of illness in which there is a major mood episode concurrent with Criterion A of schizophrenia
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
D. Not attributable to the effects of a substance or another medical condition
schizoaffective disorder
(combo of schizophrenia and mood disorder- depression or bipolar)
What are the 2 subtypes of schizoaffective disorder?
- Bipolar type – applies if patient has had a history of manic episode(s)
- Depressive type – no history of manic episodes (2 + weeks)
What primary psychiatric disorder is being described:
- Presence of one (or more) delusions with a duration of 1 month or longer
- Criterion A for schizophrenia has never been met
- Functioning is not impaired outside of the direct impact of the delusions
- Mood symptoms, if present, have been brief relative to the delusional periods
- Not attributable to another medical or psychiatric illness
delusional disorder
What is the most common subtype of delusional disorder?
persecutroy
What are the 6 subtypes of delusional disorder?
Persecutory – Most common subtype
- Erotomanic
- Jealous – More common in males
- Grandiose
- Somatic
- Mixed
What is the most common delusional disorder subtype in males?
jealous delusional disorder
Delusional disorder is/is not often resistant to antipsychotic medications alone
is
(therapy is useful)
• Delusional disorder late in life increases risk for
dementia
What is the single most important intervention outside of antipsychotic medication regarding schizophrenia?
family education
Which of the antipsychotic medicatons can cause agranulocytosis (decrease neutrophil count) as a side effect and must be closely monitored?
clozapine (clozaril)
Most antipsychotics target which receptor?
D2 dopamine receptor
What are some of the most commonly used and affordable antipsychotics?
risperidone and olanzapine
First gen antipsychotics are consicered typical/atypical and what is the mechanism of action?
typical
Dopamine Receptor Antagonists (DRA) - High Affinity for D2 receptors
Which two first gen antipsychotics (FGA) are stilled used?
haloperidol and fluphenazine
FGA cause sedation and are considered “major “.
tranquilizers
What are 3 major extrapyramidal symptoms (EPS) caused by FGAs?
- Akathisia= restlessness
- Dystonic reactions= stiff muscles
- Parkinsonism – tremors, bradykinesia, “Thorazine Shuffle”
What is akathisia?
restlessness
causes pacing
What is tardive dyskinesia and what type of drug causes its symptoms?
FGAs
involuntary movements, repetive, grimace, eye blinking, arems
Second Generation Antipsychotics (SGA) are also called “ Antipsychotics”
Atypical
Why are SGAs or second gen antipsychotics called atypicals?
Their MOA includes Serotonin-Dopamine Antagonist (SDA) & Partial Dopamine Antagonist (PDA) vs. full dopamine (D2 receptor) antagonist
Which SGA when given in high doses can act as an antagonist and when given in low doses act as an agonist?
partial dopamine antagonists (PDA)
Which 2 SGAs are considerd partial dopamine antagonists?
- Aripiprazole (Abilify) - PDA
- Brexpiprazole (Rexulti) - PDA
Which SGA can also cause increased levels of prolactin which could lead to lactation and gynecomastia?
risperidone
What are the 6 SGAs that are most commonly used?
Which type of SGAs will most likely cause metabolic side effects such as • Hyperlipidemia • Hyperglycemia • Weight Gain?
those that end with -apine
clozapine
olanzapine
quetiapine
Name 7 possible side effects of SGAs?
neuroleptic maligant syndrom can be caused by which group of antipsychotics?
first generation antipsychotics
What are some other medications, other than antipsychotics, that can treat psychosis?
benzodiazepines
pimavanserin= for Parkinson’s psychosis
What is the best drug for treating psychosis along with catatonia?
benzos
What can benzos treat as concerning psychotic patients:
agitation, catatonia with psychosis
What is best to treat acute psychosis with agitation?
Short-acting IM FGA or SGA
Which drug can be used to treat akathisia, a side effect of FGAs?
Beta blockers (propranolol)
What drug class can be used to treat EPS from FGAs?
anticholinergic medications
What drug can be used to treat Parkinson’s psychosis and is the only antipsychotic that doesn’t target D2 receptors?
Pimavanserin
a progressive neurodevelopmental & neurodegenerative disease with a waxing and waning course and a poor overall prognosis
schizophrenia
If psychotic symptoms start in an older person, strongly consider alternatives to schizophrenia, such as Huntington’s or dementia
abruptly
Positive/negative symptoms respond the best to current medications
positive
What is the best model for treatment of psychiatric disorders?
biopsychosocial
