Lecture 30- Psychotherapeutic Medications Cont. Flashcards
Final Exam!!
What is schizophrenia?
- encompasses “thought disorders”
- disturbances in areas of function such as language, affect, perception, and behavior
How many people are affected by schizophrenia?
around 1% of the population, higher in men
What is schizoaffective disorder?
- has a mood component:previous or concurrent depressive/manic episode
What is paranoid schizophrenia?
- delusions and/or auditory hallucinations
- not visual hallucinations, grandiose, scared people are out to get them
What do antipsychotics treat?
- 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
What is the dopamine hypothesis?
- 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
Antipsychotics- What are first generation drugs and what do they do?
- phenothiazines
- antagonists of dopamine receptors that work on D2 receptor sites
Which regions do phenothiazines affect?
- Reticular activating system- seems to change people’s conscious state and behavioral arousal
- Limbic system- emotional arousal
- Hypothalamus- important in metabolim and alertness
Antipsychotics- first generation side effects on motor functioning
- 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)
What pathway do first generation antipsychotics affect?
the nigro-striatal pathway which plans and modulates movement
What is tardive dyskinesia?
- dyskinesia=disordered
- tardive dyskinesia is jerky, uncontrollable movement even when sitting still
Besides, motor function impairment, what is another side effect of first generation antipsychotics?
- block of acetylcholine receptors
- this causes dry mouth, dry eyes, constipation, and sexual dysfunction
What did the field try to do after first generation psychotics?
- effort to look for different molecular targets that provide symptom relief and reduce side effects
What are 2nd generation antipsychotics?
- atypical antipsychotics
- non-phenothiazines
- includes clozapine and risperidone
What are the advantages of 2nd generation antipsychotics?
- reduced receptor blockage in nigro-striatal pathway
- greater impact on serotnin system than dopamine system (first generations are the reverse)
2nd generation antipsychotics side effects
- weight gain
- agranulocytosis (bone marrow doesn’t produce white blood cells)
- fatal myocarditis (inflammation of the heart lining that can lead to death)
First vs. second generation antipsychotics
- tardive dyskinesia and other motor effects reduced
- greater quality of life
- overall symptom improvement
Antipsychotics
What does aripiprazole (abilify) do?
- 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
Other NT involved in psychosis
- glutamate system (ketamine?)
- GABA system
- Cannabinoid system
What can antipsychotics be used to treat besides schizophrenia?
- mania
- agitated depression
- drug-induced psychoses
- emotionally unstable personalities
- psychoses w/ old age
How many people have depression and how does it vary per person?
- 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
What are the causes of depression?
- both genetic (endogenous)
- and enviornmental (exogenous)
What is thought to cause depression?
- decreases in catecholamines (particularly serotonin)
- due to observations of reserpine effects
- amygdala and reticular formation
What is the serotonin hypothesis?
- 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
Antidepressants: stimulants
- have been attempted as a form of treatment in the past
- not a great solution due to addictiveness and side effects
Anti-depressants- MAOIs
- monoamine oxidase inhibitors (1950s)
- nardil (phenylzine), parnate (tranyl cypromine)
What are cyclics?
- 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-
How do MAOIs work?
- monoamine oxidase inhibitors
- prevent breakdown of monoamines, maintains monoamines in synapse longer
What do tricyclics do?
- block 5-HT and noradrenaline (NA) transporters, increasing thir availability in the synapse
- Also blocks various postnaptic receptors including histamine and muscarinic acetylcholine
What are heterocyclics and what do they do?
- Selective serotonin reuptake inhibitors (SSRIs)
- Prozac, Paxil, Celexa, Lexapro
- maintains elevated levels of serotonin in synapse
MAOI side effects
- similar to cyclics
- temporary low BP, impaired sexual performance
- dietary restrictions including tyramine (in cheeses and chianti) as MAOs break down tyramine
What are tricyclic side effects?
- Drowsiness
- risk for fractures (newer meds)
- anticholinergic effects (dry mouth, constipation, difficulty urinating, blurred vision, dizziness upon standing, decreased libido, weight gain, and tachycardia)
Can you abruptly cease antidepressants?
- atypical or SSRIs should not be abruptly stopped using bc can cause significant anxiety or other symptoms
Atypical antidepressants
- SNRIs (5-HT and norepinephrine): cymbalta and effexor
- Weak DNRI (dopamine and norepinephrine): wellbutrin
