Neuroleptics/Antipsychotics aka Major Tranquilisers

Question 1

Neuroleptics

Antipsychotics

Answer 1

N- drug “seizes” nervous system- holds constant.

A- drug alleviates psychotic symps (not really true)- makes Catatonia worse.
–just makes people less bothered about psychosis.

Question 2

Major Tranqs

Answer 2

(contrast minors- Miltown & Bzs).

first Chlorpromazine- most potent.
Haloperidol- first “atypical” antipsych.
Risperidone- mid 1990s.

Question 3

Major Therapeutic/Clinical effects

Answer 3

1- Cam agitation & reduce behavioral activity- works even when patient isn’t sleepy.

2- Induce psych indiff- uninterested in things, very general- not just psychotic phenomena.
–induces the 5 As - Asocial, Anhedonia, Alogia, Affective Flattening, Avolia.

Question 4

Mechanism of action

Answer 4

• mostly by blocking dop (D2) receptors.

- -mesolimibic system- concerned motivation, drive, pleasure- detailed muscle control. Blunt emotion.

Question 5

Atypical antipsychotics

Answer 5

Isperidone first. Quetiapine.

• -Aripiprazole (ability)- most profitable drug in world (6 billion a year).
• -weaker D2 blocker also Serotonin S2 blockers- sedation, weight gain (Olanzapine- esp).

Question 6

Side effects

Answer 6

1- Dysphoric “feel bad”- patients dislike taking them, all experience neg symps some worse than others.
–Akathinsia- inner turmoil, extreme discomfort–> led to suicide.

2- LT use= Dependence- too rapid withdrawal= psychotic breakdown.

3- Dyskinesia- abnormal movements, rigid muscles, tremor, tongue protrusion.
—Tardive Dyskinesia (delayed)- permanent abnormal movements face, cheeks, tongue.

Question 7

Clinical use of antipsychotics

Answer 7

1- Calming agitation.

2- Suppress undesired behaviour- delirious, demented, mentally handicapped.

3- Sz, Mania & Psychotic Depress.

4- Bipolar Disorder- relabeled “mood stabilizers”- most common use antipsychoitcs now.

-useful in ST. Minimize use if possible- currently overused.