Lecture 11+12 Flashcards
mesolimbic pathway for dopamine
Projections from ventral tegmental area (VTA) to Nucleus Accumbens (NA)
reward, reinforcement, motivation, motor function
seen to lead to + symptoms
mesocortical pathway of dopamine
seen to lead to - symptoms
Projections from VTA to DLPFC
Executive functions
Projections from VTA to VMPFC
Emotions & affect
Nigrostriatal Pathway of dopamine
pathway responsible for extrapyramidal syndrome
Projections from substantia nigra to striatum (caudate and putamen)
Stimulation of purposeful movement)
Tuberoinfundibular Pathway of dopamine
pathway that can lead to increased prolactin release
Projections from the hypothalamus to the infundibular region
Normally inhibits prolactin release
Schizophrenia treatment
First generation neuroleptics (e.g., chlorpromazine)
Second generation neuroleptics (e.g., clozapine)
most of them are D2 receptor antagonists but some block D2 receptors too
first generation antipsychotics (typical)
Ex: chlorpromazine and haloperidol
D2 antagonist
will relieve positive symptoms
side effects:
Extrapyramidal syndrome
Neuroleptic Malignant Syndrome
extrapyramidal syndrome
- dystonia (distained muscle contraction)
seen within first week - parkinsonism (PD like symptoms)
usually seen within a few months - Akathisia (restlessness)
seen within a few months - tardive dyskinesia (Repetitive, involuntary, purposeless movements of the face and extremities)
seen as a long-term side effect after years of treatment
Neuroleptic Malignant Syndrome (NMS)
Characterized by tachycardia, hypertension, rapid respiration, fever, extreme rigidity, delirium, & death
usually seen within 2 weeks of starting the medication or after a dosage increase
most likely due to the drop in dopamine that impacts hypothalamic function
Second Generation (Atypical) Antipsychotics
Ex: Clozapine, risperidone, olanzapine
Mechanism of Action: D2, 3, 4 and 5-HT2A receptor antagonist
will relieve positive and negative symptoms
side effects:
Agranulocytosis (only Clozapine)
Lowered risk of extrapyramidal syndrome
additional side effects of anti psychotics
weight gain
sedation
sexual dysfunction
Schizophrenia treatment
psychosocial environmental support
(housing and social support, family ed, psychotherapy)
ECT augmentation:
Used for medication-refractory schizophrenia
catatonic type
Schizophreniform Disorder Diagnosis
similar symptoms to schizophrenia but has a different duration
total duration of symptoms more than one month but less than 6 months
sometimes provisional for schizophrenia until 6 months is reached
Brief Psychotic Disorder Diagnosis
At least one core psychotic domain symptom
the episode is less than one month duration
person will return to normal
will be triggered by a stressor
Schizoaffective Disorder Diagnosis
Active Phase of schizophrenia occurs concurrently with a major mood episode (MDE or mania)
active phase will last more than 2 weeks without mood symptoms
can be bipolar or depressive sub-type
delusional disorder diagnosis
must have a delusion
symptoms lasts longer than 1 month
no other psychotic symptoms
no functional impairment aside from the impact of the delusion
can be:
Non-bizarre delusion: A belief that involves something
that could occur in real life; is physically possible.
Bizarre delusion: A belief that is clearly implausible and
not derived from ordinary life experiences.
A delusion may develop in the context of a close relationship with a psychotic individual!!!
