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!!!
Delusional Disorder Subtypes
Persecutory Type: Belief of malevolent treatment
Grandiose Type: Belief of having some great (but
unrecognized) talent or insight or having made some
important discovery
Erotomanic Type: Belief that someone else is in love with the individual
Jealous Type: Belief of infidelity by partner
Somatic Type: Belief involving bodily functions/sensations, such as parasitosis, malodorous, organ dysfunction
etiology and treatment for delusional disorder (DD)
etiology:
can be genetically linked
dopamine/ serotonin imbalance
triggered by environment
treatment:
antipsychotics
CBT (change thought patterns and behaviors)
family therapy
Close relationship delusion disorder treatment
Trial separation from partner
Increasing sources of reality testing (CBT) to recognize and change thought patterns and behaviors
what are the Cluster A personality disorders
paranoid
schizoid
schizotypal
(odd-eccentric)
what are the Cluster B personality disorders
histrionic
borderline
narcissistic
antisocial
dramatic/emotional/erratic
what are the Cluster C personality disorders
avoidant
dependent
obsessive-compulsive
(anxious and fearful)
treatment and prognosis of personality disorders
CBT is usually done
meds can be used with therapy
treatment is difficult:
patient disinterest in treatment
harder for them to unlearn behaviors
Paranoid Personality Disorder (PPD)
cluster A disorder
these people are distrustful and suspicious
typically a gradual and childhood onset
paranoid thoughts are suspected.. not not certain
thus cannot be delusion disorder
Schizoid Personality Disorder
Cluster A
interpersonal detachment
lacks close friends
lacks desire for relationships
emotional coldness
likes to be alone
Schizotypal Personality Disorder
cluster A
eccentric
odd beliefs odd thinking and speech odd appearance suspicious no close friends
usually do not have psychotic symptoms
these people may develop schizophrenia
Histrionic Personality Disorder
cluster B
needs to be center of attention
uses appearance for attention
shallow and rapid emotions
exaggerated emotional expression
excessive emotion (drama queen)
Borderline Personality Disorder
Cluster B
instable
unstable intense relationships (splitting) unstable mood and emotion fear of being abandon self-damaging impulsivity suicidal
treatment for BPD
Dialectical Behavioral Therapy (DBT)
Emphasis is on self-acceptance yet the need to change
The goal of breaking the sequence and regulating
emotions without acting on them
Narcissistic Personality Disorder (NPD)
Cluster B
grandiosity
requires admiration lacks empathy sense of entitlement fragile self-esteem (may get very mad if criticized) sometimes envious of others
Antisocial Personality Disorder (ASPD)
Cluster B
pervasive disregard for other’s rights
have repeated unlawful acts will be deceitful irritability and aggressive lack of remorse irresponsible reckless
must be 18 years or older
must have conduct disorder before age of 15
lack of reactivity to stressors
psychopath
