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Psyc 330- Drugs and Behavior > Lecture 30- Psychotherapeutic Medications Cont. > Flashcards

Lecture 30- Psychotherapeutic Medications Cont. Flashcards

Final Exam!!

1
Q

What is schizophrenia?

A
  • encompasses “thought disorders”
  • disturbances in areas of function such as language, affect, perception, and behavior
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2
Q

How many people are affected by schizophrenia?

A

around 1% of the population, higher in men

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3
Q

What is schizoaffective disorder?

A
  • has a mood component:previous or concurrent depressive/manic episode
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4
Q

What is paranoid schizophrenia?

A
  • delusions and/or auditory hallucinations
  • not visual hallucinations, grandiose, scared people are out to get them
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5
Q

What do antipsychotics treat?

A
  • agitation, mania, hallucinations, delusions, anger, accelterated/disorganized thinking process
  • are there to treat a variety of the symptoms, but not one medication can hit it all
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6
Q

What is the dopamine hypothesis?

A
  • originates form amphetamine-induced psychosis as model
  • Two core principles: 1. mediated by increases in dopaminergic activity (drugs like amphetamines and cocaine will do this) 2. Antipsychotics block postsynaptic DA D2 receptors
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7
Q

Antipsychotics- What are first generation drugs and what do they do?

A
  • phenothiazines
  • antagonists of dopamine receptors that work on D2 receptor sites
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8
Q

Which regions do phenothiazines affect?

A
  • Reticular activating system- seems to change people’s conscious state and behavioral arousal
  • Limbic system- emotional arousal
  • Hypothalamus- important in metabolim and alertness
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9
Q

Antipsychotics- first generation side effects on motor functioning

A
  • motor control (Parkinsonian-like syndrome) in around 50% of users
  • Dyskinesia (disordered movement), including tardive dyskenia in 1/3 of patients
  • Akinesia (slowing of movement)
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10
Q

What pathway do first generation antipsychotics affect?

A

the nigro-striatal pathway which plans and modulates movement

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11
Q

What is tardive dyskinesia?

A
  • dyskinesia=disordered
  • tardive dyskinesia is jerky, uncontrollable movement even when sitting still
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12
Q

Besides, motor function impairment, what is another side effect of first generation antipsychotics?

A
  • block of acetylcholine receptors
  • this causes dry mouth, dry eyes, constipation, and sexual dysfunction
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13
Q

What did the field try to do after first generation psychotics?

A
  • effort to look for different molecular targets that provide symptom relief and reduce side effects
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14
Q

What are 2nd generation antipsychotics?

A
  • atypical antipsychotics
  • non-phenothiazines
  • includes clozapine and risperidone
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15
Q

What are the advantages of 2nd generation antipsychotics?

A
  • reduced receptor blockage in nigro-striatal pathway
  • greater impact on serotnin system than dopamine system (first generations are the reverse)
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16
Q

2nd generation antipsychotics side effects

A
  • weight gain
  • agranulocytosis (bone marrow doesn’t produce white blood cells)
  • fatal myocarditis (inflammation of the heart lining that can lead to death)
17
Q

First vs. second generation antipsychotics

A
  • tardive dyskinesia and other motor effects reduced
  • greater quality of life
  • overall symptom improvement
18
Q

Antipsychotics

What does aripiprazole (abilify) do?

A
  • stabilizes DA by having different effects based on what the system is like for the individual
  • Targets the DA D2 receptor: D2 receptor antagonist in hyperdopaminergic state, D2 receptor agonist in hypodopaminergic state
19
Q

Other NT involved in psychosis

A
  • glutamate system (ketamine?)
  • GABA system
  • Cannabinoid system
20
Q

What can antipsychotics be used to treat besides schizophrenia?

A
  • mania
  • agitated depression
  • drug-induced psychoses
  • emotionally unstable personalities
  • psychoses w/ old age
21
Q

How many people have depression and how does it vary per person?

A
  • Among the most common psychiatric disorders, around 20% of US in lifetime
  • Caries in severity, duration, frequency, and occurrence
  • Females seem to be more sensitive to developing depression
22
Q

What are the causes of depression?

A
  • both genetic (endogenous)
  • and enviornmental (exogenous)
23
Q

What is thought to cause depression?

A
  • decreases in catecholamines (particularly serotonin)
  • due to observations of reserpine effects
  • amygdala and reticular formation
24
Q

What is the serotonin hypothesis?

A
  • serotonin identified as primary target because when looking at metabolite levels in CSF there are patterns of reduced serotonin
  • Brainstem is where the raphe nucleus is located, may be alterations leading to serotonin dysregulation
25
Q

Antidepressants: stimulants

A
  • have been attempted as a form of treatment in the past
  • not a great solution due to addictiveness and side effects
26
Q

Anti-depressants- MAOIs

A
  • monoamine oxidase inhibitors (1950s)
  • nardil (phenylzine), parnate (tranyl cypromine)
27
Q

What are cyclics?

A
  • tricyclics (1950s) and heterocyclics (SSRIs)
  • heterocyclics more effective than tri- and have fewer side effects
  • heterocyclics have varies types of rings making it chemically different than tri-
28
Q

How do MAOIs work?

A
  • monoamine oxidase inhibitors
  • prevent breakdown of monoamines, maintains monoamines in synapse longer
29
Q

What do tricyclics do?

A
  • block 5-HT and noradrenaline (NA) transporters, increasing thir availability in the synapse
  • Also blocks various postnaptic receptors including histamine and muscarinic acetylcholine
30
Q

What are heterocyclics and what do they do?

A
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Prozac, Paxil, Celexa, Lexapro
  • maintains elevated levels of serotonin in synapse
31
Q

MAOI side effects

A
  • similar to cyclics
  • temporary low BP, impaired sexual performance
  • dietary restrictions including tyramine (in cheeses and chianti) as MAOs break down tyramine
32
Q

What are tricyclic side effects?

A
  • Drowsiness
  • risk for fractures (newer meds)
  • anticholinergic effects (dry mouth, constipation, difficulty urinating, blurred vision, dizziness upon standing, decreased libido, weight gain, and tachycardia)
33
Q

Can you abruptly cease antidepressants?

A
  • atypical or SSRIs should not be abruptly stopped using bc can cause significant anxiety or other symptoms
34
Q

Atypical antidepressants

A
  • SNRIs (5-HT and norepinephrine): cymbalta and effexor
  • Weak DNRI (dopamine and norepinephrine): wellbutrin

Psyc 330- Drugs and Behavior (40 decks)

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