Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Pharmacological treatment of psychotic disorders > Flashcards

Pharmacological treatment of psychotic disorders Flashcards

1
Q

Which conditions often warrant use of antipsychotics?`

A 
Schizophrenia
Schizoaffective disorder
Bipolar disorder
Psychotic depression
Augmenting agent in treating resistant depressive or anxiety disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which pathways in the brain are affected by dopamine?

A

Mesocortical
Mesolimbic
Nigrostriatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is the mesocortical pathway involved in psychosis?

A

Negative disorders
Cognitive disorders
Problem here in psychotic patients is too little dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is the mesolimbic pathway involved in psychosis?

A

Positive symptoms

Problem here in a psychotic patient is too much dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is the nigrostriatal pathway involved in psychosis?

A

Movement regulation
Dopamine hypoactivity in this pathway leads to Parkinsonian movements
Bradykinesia, rigidity, tremors, akathisia, dystonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is the tuberoinfundibular pathway involved in psychosis management?

A

Dopamine inhibits/regulates prolactin release

Blocking dopamine in this pathway will predispose the patient to hyperprolactinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does hyperprolactinaemia present?

A

Gynecomastia
Galactorrhoea
Decreased libido
Menstrual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do typical antipsychotics work?

A

D2 dopamine receptor antagonists

High affinity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a consequence of the high affinity of high potency D2 antagonist antipsychotics?

A

Extrapyramidal side effects like Parkinsonian movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are atypical antipsychotics?

A

Serotonin-dopamine 2 antagonists (SDAs)

Considered atypical for affect dopamine and serotonin neurotransmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is risperidone?

A

Atypical antipsychotic
Likely to induce hyperprolactinaemia
Weight gain and sedation
Monthly IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some drawbacks of the atypical antipsychotic olanzipine?

A

Weight gain
Raised glyceride, cholesterol, glucose
Hyperprolactinaemia
Acute dystonic reaction including oculogyric crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some pros of the atypical antipsychotic olanzipine?

A

Use as immediate release IM good for compulsory medication

Also comes in regular tabs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some drawbacks of the atypical antipsychotic quetiapine?

A

Abnormal LFTs
Weight gain
Raised cholesterol, triglyceride, glucose
Orthostatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some pros of quetiapine?

A

Sedative effect useful for conjunctive treatment for depression (sleep) or schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some pros of aripiprazole?

A

Available as regular tab or immediate release IM
No QT prolongation
Not associated with weight gain
Lower incidence of extrapyramidal side effect

17
Q

Why does aripiprazole have a lower incidence of extrapyramidal side effects?

A

Mechanism of action as a D2 partial agonist results in balancing dopamine deficiencies

18
Q

What are some drawbacks of aripiprazole?

A

Interactions with fluoxetine and paroxetine

Could cause intolerability due to akathisia/activation

19
Q

What is a good atypical antipsychotic option for treatment resistant patients?

A

Clozapine

Generally reserved for resistant patients due to side effects

20
Q

What are some side effects of clozapine?

A 
Agranulocytosis
Increased risk of seizures
Sedation
Weight gain
Abnormal LFTs
Hyperosmolar coma
Raised cholesterol, glucose, triglyceride
21
Q

Why do patients on clozapine have to get weekly blood tests?

A

Agranulocytosis may lead to death

Blood test will show any reduction in neutrophils

22
Q

What is Tardive Dyskinesia (TD)?

A

Involuntary muscle movements that may not resolve with drug discontinuation

23
Q

What is neuroleptic malignant syndrome (NMS)?

A 
Severe muscle rigidity
Fever
Altered mental status
Autonomic instability
Elevated WBC
Abnormal LFTs
Potentially fatal
24
Q

How are extra pyramidal side effects managed?

A

Reduce dose if possible
Anticholinergics like benztropine
Dopamine facilitators like amantadine
Propanolol

25
Q

What are some associations of a 3rd episode of schizophrenia?

A

Clear link to reduced functioning, lower IQ, negative symptoms
Consider long acting IM

26
Q

What are some tests to run before commencing on antipsychotics?

A

LFT
Fasting lipid profile
Fasting blood sugar
CBC

27
Q

Which conditions are benzodiazepines used for?

A

Insomnia
Parasomnias
Anxiety disorders
CNS depressant withdrawal protocols

28
Q

What are some side effects of benzodiazepines?

A 
Somnolence
Cognitive deficits
Amnesia
Disinhibition
Tolerance
Dependence
29
Q

What is another name for diazepam?

A

Valium

30
Q

How do we avoid benzodiazepine dependence?

A

Treat underlying cause

Reserve for short term uses like sedation or withdrawal states

31
Q

What would be a good treatment option for non-compliant patients suffering from schizophrenia or other psychotic disorders?

A

Depot antipsychotic

IM injection every 2-4 weeks

32
Q

What is involved in the acute phase of bipolar disorder treatment?

A

Stop any antidepressants
Start antipsychotic, lithium or mood stabiliser
Consider adding short term benzodiazepine
Combine antipsychotic and lithium if response is inadequate

33
Q

What is involved in the management phase of bipolar disorder?

A

Lithium/olanzapine/valproate/quetiapine for at least 2 years
Antidepressants/CBT for intercurrent depression
Combine mood stabilisers for rapid cycling conditions

34
Q

What is acute dystonic reaction?

A

Involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx in either sustained or intermittent patterns that lead to abnormal movements or postures
Oculogyric crisis

35
Q

What effect does dopamine have on prolactin release and how might this be clinically relevant?

A

Dopamine inhibits prolactin release
Typical antipsychotics inhibit dopamine receptors
This may cause galactorrhoea

Psychiatry (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions