Pharmacology of Psychosis - Mood Disorders

Question 1

Pharmacologically, what is the difference between typical and atypical antipsychotics?

Answer 1

Typical block more D2 than 5HT2a

Atypical block more 5HT2a than D2

Question 2

Psychosis usually presents with increased dopamine in the __________ system and decreased dopamine in the ____________ system.

Answer 2

mesolimbic (leading to positive symptoms –hallucinations, disorder speech, etc.); mesocortical (leading to negative symptoms –flat affect, apathy, etc.) and hippocampal (hence, cognitive dysfunction)

Question 3

The antipsychotic that causes sialorrhea also causes what worrisome side effects?

Answer 3

agranulocytosis, lowered seizure threshold, and antimuscarinic symptoms (this being clozapine)

Question 4

The ___________ pathway is involved in communication and social aptitude.

Answer 4

mesocortical system (hence, decreased dopamine here leads to poverty of speech and social withdrawal)

Question 5

Agonists of the ________ receptor produce hallucinations.

Answer 5

5HT2a (this is how LSD works)

Question 6

Why would you want to block 5HT2a in schizophrenia?

Answer 6

Because stimulating the dopaminergic neurons in the prefrontal cortex leads to decreased dopamine release; thus, blocking 5HT2a leads to increased dopamine release

Question 7

Other than dopamine in the mesolimbic system, positive schizophrenic symptoms are also caused by ____________.

Answer 7

decreased glutamate in the prefrontal cortex

Question 8

Which antipsychotic is also a partial agonist of the D2 receptor?

Answer 8

Aripiprazole

Question 9

True or false: typical antipsychotics have a lower incidence of prolactinemia.

Answer 9

False. Atypical antipsychotics

Question 10

True or false: D2 receptors in the hypothalamus mediate the toxic-chemical emetic response.

Answer 10

True! As such, typical antipsychotics have an anti-emetic effect.

Question 11

Acute dystonia (like torticollis), akathisia, tardive dyskinesia, and drug-induced Parkinson’s are all potential side effects of typical antipsychotics. What timeline does each usually present?

Answer 11

Acute dystonia (1-6 days)
Akathisia (6-60 days)
Drug-induced Parkinson’s (5-90 days)
Tardive dyskinesia (3-6 months)

Question 12

True or false: anticholinergics are used to treat tardive dyskinesia.

Answer 12

False. Treatment of tardive dyskinesia is rarely effective.

Question 13

What agents is commonly used to treat drug-induced akathisia?

Answer 13

Beta-blockers

Question 14

At what site does blockade of D2 receptors lead to metabolic syndrome?

Answer 14

Hypothalamus

Question 15

SSRIs are less effective than tricyclic antidepressants in the treatment of _____________.

Answer 15

neuropathic pain

Question 16

Why does blocking 5HT2A receptor help treat negative symptoms?

Answer 16

Because stimulating 5HT2A receptors in the PFC leads to decreased dopamine release in the mesocortical system

Question 17

_______-function of the NMDA receptors leads to both positive and negative symptoms.

Answer 17

Hypo; this is part of the decrease in glutamate activity seen in those with psychosis

Question 18

True or false: blocking D2 receptors is a part of every successful therapies for positive symptoms.

Answer 18

False. Some agents have been shown to decrease positive psychotic symptoms without blocking D2

Question 19

In which patients is clozapine indicated?

Answer 19

Those who haven’t responded to other treatments

Question 20

Long-term use of typical anti-psychotics does what to dopamine cells?

Answer 20

It makes them supersensitive.

Question 21

In the blood stream, most anti-psychotics are ______________.

Answer 21

bound to proteins

Question 22

Postural hypotension is a side effect of which antidepressant?

Answer 22

MAOi

Question 23

True or false: lithium is able to treat acute mania.

Answer 23

False. It takes days to become effective.