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Psychiatry > Management and neurobiology of schizophrenia > Flashcards

Management and neurobiology of schizophrenia Flashcards

1
Q

What was the first discovered anti-psychotic?

A

Chlorpromazine

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2
Q

What are the 2 types of classifications of anti-psychotics?

A

Typical vs atypical
1st vs 2nd vs 3rd generation

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3
Q

What is the main theory of schizophrenia pathophysiology?

A

Dopamine theory

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4
Q

What are the 5 main dopamine pathways?

A
  • Mesocortical pathway
  • Mesolimbic pathways
  • Nigrostriatal pathway
  • Hypothalamic pathway
  • Tuberoinfundibular pathway
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5
Q

What is the role of the mesocortical and mesolimbic pathways in schizophrenia?

A

The mesocortical and mesolimbic run through the higher cortical regions pathways and seem to be involved in positive symptoms of schizophrenia such as hallucinations, delusions and thought disorders

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6
Q

Function of the nigrostraital pathway

A

Movement

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7
Q

Function of the tuberoinfundibulnar pathway?

A

Hormone secretion from the pituitary gland (Especially prolactin)

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8
Q

Function of the hypothalamic pathway

A

Runs from movement centres into the spinal tract

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9
Q

What is the MOA of the ideal anti-psychotic?

A

D2 dopamine receptor antagonist of the mesolimbic pathway

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10
Q

What are some other neurotransmitters thought to be associated with schizophrenia?

A

Glutamine (NMDA receptor)
Serotonin

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11
Q

Examples of 1st generation, typical anti-psychotics?

A

Haloperidol
Prochlorperazine
Fluphenazine
Chlorpromazine
Trifluperazine

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12
Q

MOA of 1st generation, typical anti-psychotics?

A
  • Non-selectively block D2 and other receptors
  • Reduce positive symptoms
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13
Q

Examples of 2nd generation, atypical anti-psychotics

A

Olanzapine
Rispiridone
Quetiapine
Aripiprazole
Clozapine
Amisulpride
Lurasidone

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14
Q

MOA of 2nd generation, atypical anti-psychotics

A
  • Work on D2 and 5HT-3 (serotonin) to reduce side effect profile
  • Also work on H1, alpha and cholinergic
  • Reduce positive symptoms with no worsening of negative symptoms
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15
Q

What are some side effects of anti-psychotics on the nigrostriatal pathway (Extra-pyramidal)

A

Acute dystonic reaction
Parkinsonism
Tardive dyskinesia

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16
Q

What are some effects of acute dystonic reaction?

A
  • Onset in minutes
  • Increasing muscle tone
  • Energetic
  • Torticolis
  • Oculogyric crisis
  • Tongue protrusion
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17
Q

What is Parkinsonism?

A
  • Bradykinesia
  • Cogwheeling rigidity
  • Resting tremor
  • Shuffling gait
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18
Q

What is tardive dyskinesia?

A
  • Long-term and often permanent
  • Involuntray, repetetive orofacial movements
  • Blinking, grimacing, pouting, lip-sacking
19
Q

Side effects of anti-psychotics affecting the tuberoinfundibular pathway

A

Neuroleptic malignant syndrome
Hyperprolactinaemia

20
Q

What are some side effects of anti-psychotics affecting the hypothalamic pathway

A

Akathesia (Restless legs)

21
Q

What causes extra-pyramidal pathway symptoms to occur with anti-psychotics?

A

caused by an imbalance of acetylcholine and dopamine signalling

22
Q

How can extra-pyramidal symptoms be managed in anti-psychotic use?

A

symptoms can be treated by depleting the levels of acetylcholine signalling to match the depleted levels of dopamine signalling, therefore anticholinergics can be given

23
Q

What are some examples of anti-cholinergics given to reduce extra-pyramidal symptoms of anti-psychotics

A
  • Procyclidine 5mg PO or IM
  • Trihexyphenidyl
  • Orphenadrine
24
Q

What is neuroleptic malignant syndrome

A

A triad of:
- Autonomic instability (E.g. heart rate, temperature control)
- malignant hyperpyrexia
- Increasing muscle tone

It is potentially fatal

25
Q

How is neuroleptic malignant syndrome managed?

A
  • Stop antipsychotic
  • Rapid cooling, renal support
  • Muscle relaxants
  • Dopamine agonists
26
Q

How does hyperprolactinaemia present in women?

A
  • Galactorrhoea
  • Low libido, low arousal, anorgasmia
  • Amenorrhoea
  • Anovulation
27
Q

How does hyperprolactinaemia present in men?

A
  • Gynaecomastia
  • Erectile dysfunction
  • oligospermia
  • Low libido
28
Q

How does hyperprolactinaemia present in both men and women?

A
  • Decreased bone mineralisation
  • Low bone density → Osteoporosis
  • Falls → Fractures
29
Q

How do antipsychotics cause hyperprolactinaemia?

A

Dopamine inhibits prolactin, so decreasing dopamine transmission increases prolactin

30
Q

What is akathisia?

A

The inability to sit at peace (Restlessness)

31
Q

How does akathisia present?

A
  • Pacing
  • Rocking foot to foot
  • Unable to sit or stand still
  • Poor sleep
32
Q

How is akathisia managed?

A

ß-blocker used to treat (E.g. propranolol) or benzodiazepines (2nd line)

33
Q

What is the most effective antipsychotic?

A

Clozapine

34
Q

What are the advantages of clozapine

A

Good for -ve syndromes and anti-suicidal properties

35
Q

What are some of the side effects of clozapine?

A
  • Agranulocytosis → Neutropenic sepsis
  • Myocarditis
  • Constipation → Gastric paresis → Obstruction → Perforation
  • Weight gain (10kg in 3 months average)
  • Sedation
  • Sialorrhoea
36
Q

What are some other symptoms of anti-psychotics?

A
  • Orthostatic hypotension
  • Anticholinergic side effects
  • Weight gain
  • Sedation
  • Haloperidol linked with prolonged QT
37
Q

What monitoring is required for clozapine use?

A
  • ECG and FBC before starting
  • FBC every week for 18 weeks then every 2 weeks thereafter
  • Patient must notify if started or stopping smoking
  • Weight calculated on each visit to ensure dose remains in therapeutic range
38
Q

What is an adverse effect of risperidone

A

Most likely to cause EPSE and increased PRL side effects (e.g. galactorrhoea)

39
Q

Side effects of olanzapine

A

metabolic syndrome

40
Q

Side effects of quetiapine

A

sedation and weight gain

41
Q

Prognosis of schizophrenia

A

People with schizophrenia die 10-20 years before the rest of the population

42
Q

Why is life expectancy reduced in schizophrenia?

A
  • Poverty
  • Poor diet
  • Lack of support
  • Chronic health conditions
  • Poor access to transport
  • Amotivation → Reduced exercise
  • Poor concentration → Missed appointments, prescriptions, scans
  • Higher rates of smoking
  • Co-morbid drug use
43
Q

What are some brain changes seen in schizophrenia?

A

Enlarged ventricles
Reduced fronton-temporal volume
Reduced activation of prefrontal areas on specific tasks

44
Q
A

Psychiatry (29 decks)

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