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PCL 200 > Drugs for Schizophrenia > Flashcards

Drugs for Schizophrenia Flashcards

1
Q

Who is affected by schizophrenia

A
  • almost 1% of the population
  • more men than women
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2
Q

“prodromal period” of schizophrenia

A

of 2-5 years before diagnosis (subclinical behavioral changes noted by friends and family)

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3
Q

Causes of schizophrenia

A
  • 80% genetic risk
  • Urbanicity is a risk factor
  • prenatal development and early childhood
  • early cannabis use
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4
Q

Positive/ Psychotic Symptoms

A

presentation of behaviours that are not normally seen in healthy people

(Hallucinations, delusions and illogical disturbances in the flow, order, and content of though)

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5
Q

Negative symptoms

A

lack of behaviours that are normally present in healthy people

(avolition- decreased motivation, anhedonia- decreased ability to experience pleasure or identify activities as being pleasurable, flattened affect- lack of emotion/ expression, poverty of speech- small vocab, social withdrawal)

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6
Q

Neurological changes caused by Schizophrenia

A
  • enlarged lateral ventricles
  • reductions in white matter tracts
  • reduced grey matter
  • reduced synapses (not cell #)
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7
Q

Environmental Risk Factors of schizophrenia

A
  • Maternal starvation or infection in 2nd
    trimester
  • Infection with plasmodium gondii (cat feces)
  • Obstetric complications
  • Physical or psychological abuse/trauma in childhood
  • Low socioeconomic status
  • Urbanicity
  • Drug exposure (amphetamine, cannabis, phencyclidine)
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8
Q

Who discovered the first antipsychotics?

A

Henri Laborit (French surgeon)

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9
Q

Why did Laborit and Rhone-Poulenc develop the antipsychotic?

A
  • was trying to develop new anesthetics that would be a combination of sedative, narcotic and hypnotic
  • lowered body temperature with “reduced antihistamine and enhanced sedative properties”
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10
Q

The first antipsychotic/ the “chemical lobotomy”

A

Chlorpromazine

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11
Q

target for all antipsychotics

A
  • D1 & D2 dopamine receptors
  • Antipsychotics are all antagonist for D2 receptors
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12
Q

First Generation/ Typical Antipsychotics

A

CHLORPROMAZINE
HALOPERIDOL

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13
Q

Second Generation/ Atypical Antipsychotics

A

CLOZAPINE
OLANZAPINE
RISPERIDONE

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14
Q

Adverse reactions to 1st generation APS

A
  • Parkinsonian effects
  • Tardive dyskinesia
  • Hyperprolactinemia
  • anhedonia
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15
Q

Hyperprolactinemia

A

elevated prolactin hormone causes breast development in men & women, lactation in women, impotence in men, disruptions in menstrual cycle in women

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16
Q

Anhedonia

A

reduced ability to experience pleasure due to D2R antagonism

17
Q

Extrapyramidal Side Effects (EPS)

A
  • First generation APS can cause immobility and muscle rigidity similar to Parkinson’s disease at or near therapeutic dose
    • Can also cause dystonia or akathisia/ restlessness
      • Thought to be a result of D2 antagonism
18
Q

Tardive Dyskinesia

A
  • Occasionally occurs after long-term treatment with typical APS
    • Symptoms persist even after APS is discontinued
      • Patients have involuntary twitches of facial muscles predominantly, but also hands and legs
19
Q

Positive reactions to 1st generation APS

A
  • antiemetic properties (preventing or treating nausea and vomiting)
  • do not cause withdrawal symptoms
20
Q

Adverse reactions to 2nd generation APS

A
  • Metabolic disorders
  • Cardiovascular disorders
  • Blood disease (clozapine)
21
Q

Clozapine target

A

antagonizes serotonin receptors (5HT2A) as well as dopamine D2 receptors (also acts on other receptors – muscarinic, histamine).

22
Q

First discovered 2nd Generation APS

A

Clozapine (1960s)
- Did not cause parkinson’s side effect

23
Q

Olanzapine

A

Causes extreme weight gain
can cause 20-40 pound gains in one month) – increase in appetite

24
Q

Positive reactions to 2nd generation APS

A
  • Do not cause Parkinsonian motor impairments (EPS) and tardive dyskinesia
  • have dual actions on serotonin and dopamine receptors
25
Q

“treatment-resistant” schizophrenia is best treated with

A

clozapine
(not chosen first because of risk for WBC- white blood cell loss)

26
Q

2 NEW IDEAS ABOUT THE CAUSES OF SCHIZOPHRENIA

A
  1. A rare de novo mutation in one of hundreds of genes that can lead to schizophrenia
  2. A combination of several risk genes plus environmental stressors

PCL 200 (11 decks)

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