Pharmacology of Psychosis - Mood Disorders Flashcards
Pharmacologically, what is the difference between typical and atypical antipsychotics?
Typical block more D2 than 5HT2a
Atypical block more 5HT2a than D2
Psychosis usually presents with increased dopamine in the __________ system and decreased dopamine in the ____________ system.
mesolimbic (leading to positive symptoms –hallucinations, disorder speech, etc.); mesocortical (leading to negative symptoms –flat affect, apathy, etc.) and hippocampal (hence, cognitive dysfunction)
The antipsychotic that causes sialorrhea also causes what worrisome side effects?
agranulocytosis, lowered seizure threshold, and antimuscarinic symptoms (this being clozapine)
The ___________ pathway is involved in communication and social aptitude.
mesocortical system (hence, decreased dopamine here leads to poverty of speech and social withdrawal)
Agonists of the ________ receptor produce hallucinations.
5HT2a (this is how LSD works)
Why would you want to block 5HT2a in schizophrenia?
Because stimulating the dopaminergic neurons in the prefrontal cortex leads to decreased dopamine release; thus, blocking 5HT2a leads to increased dopamine release
Other than dopamine in the mesolimbic system, positive schizophrenic symptoms are also caused by ____________.
decreased glutamate in the prefrontal cortex
Which antipsychotic is also a partial agonist of the D2 receptor?
Aripiprazole
True or false: typical antipsychotics have a lower incidence of prolactinemia.
False. Atypical antipsychotics
True or false: D2 receptors in the hypothalamus mediate the toxic-chemical emetic response.
True! As such, typical antipsychotics have an anti-emetic effect.
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?
Acute dystonia (1-6 days)
Akathisia (6-60 days)
Drug-induced Parkinson’s (5-90 days)
Tardive dyskinesia (3-6 months)
True or false: anticholinergics are used to treat tardive dyskinesia.
False. Treatment of tardive dyskinesia is rarely effective.
What agents is commonly used to treat drug-induced akathisia?
Beta-blockers
At what site does blockade of D2 receptors lead to metabolic syndrome?
Hypothalamus
SSRIs are less effective than tricyclic antidepressants in the treatment of _____________.
neuropathic pain
Why does blocking 5HT2A receptor help treat negative symptoms?
Because stimulating 5HT2A receptors in the PFC leads to decreased dopamine release in the mesocortical system
_______-function of the NMDA receptors leads to both positive and negative symptoms.
Hypo; this is part of the decrease in glutamate activity seen in those with psychosis
True or false: blocking D2 receptors is a part of every successful therapies for positive symptoms.
False. Some agents have been shown to decrease positive psychotic symptoms without blocking D2
In which patients is clozapine indicated?
Those who haven’t responded to other treatments
Long-term use of typical anti-psychotics does what to dopamine cells?
It makes them supersensitive.
In the blood stream, most anti-psychotics are ______________.
bound to proteins
Postural hypotension is a side effect of which antidepressant?
MAOi
True or false: lithium is able to treat acute mania.
False. It takes days to become effective.
