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Psychiatry > Pharmacology of Psychotic Disorders > Flashcards

Pharmacology of Psychotic Disorders Flashcards

1
Q

What are some of the dopamine pathways in the brain that can be implicated in the development of psychotic disorders?

A

Mesocortical

Mesolimbic

Nigrostriatal

Tuberoinfundibular

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2
Q

Where is the mesocortical pathway? How can it become implicated in psychotic disorders?

A

From ventral tegmentum (brain stem) to cortex

Too little dopamine in this area can cause negative symptoms of psychotic disorders

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3
Q

Where is the mesolimbic pathway? How can it become implicated in psychotic disorders?

A

Dopaminergic cell bodies in the ventral tegmentum to the limbic system

Too much dopamine here can cause the positive symptoms of psychotic disorders (hallucinations etc.)

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4
Q

Where is the nigrostriatal pathway? How can it become implicated in psychotic disorders?

A

From the substantia nigra to the basal ganglia

Dopamine Hypoactivity in this area can cause Parkinsonian movements (rigidity, bradykinesia, tremors), akathisia and dystonia

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5
Q

What happens if you block dopamine in the tuberoinfundibular pathway?

A

Dopamine release inhibits the relase of prolactin

Therefore reducing dopamine in this area will lead to hyperprolactinaemia

gynecomastia, galactorrhoea, decreased libido, menstrual dysfunction

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6
Q

What is the mechanism of typical antipsychotics? Some examples of typical antipsychotics?

A

D2 dopamine receptor antagonists

Bind to the dopamine receptors with high affinity

Fluphenazine, Haloperidol, Pimozide

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7
Q

What sort of side effects may be caused by typical antipsychotics?

A

Reduce the effect of dopamine so can lead to Parkinsonian side effects

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8
Q

What is the mechanism of atypical antipsychotics?

A

Serotonin-dopamine 2 antagonists

Affect both serotonin and dopamine transmission

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9
Q

What are some examples of atypical antipsychotics?

A

Risperidone

Olanzapine

Aripiprazole

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10
Q

How effective are atypical antipsychotics?

A

1/3 good response

1/3 some response

1/3 poor response

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11
Q

What drug is used when psychosis is treatment resistant after 2+ psychotics? Why is it not first line?

A

Clozapine

Very effective but usually avoided due to its extreme side effect profile

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12
Q

What are some of the side effects of clozapine?

A 
Agranulosis (0.5 - 2%)
Significant sedation and weight gain
Abnormal LFTs 
Risk of seizures (esp. when with lithium)
Hypertriglyceridaemia
hypercholesterolaemia 
hyperglycaemia
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13
Q

Due to the agranulosis that can occur with clozapine, what is necessary when starting the drug?

A

Weekly bloods for 6 months

Followed by bloods every 2 weeks for 6 months

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14
Q

How effective is clozapine?

A

Among the treatment resistant cases:

1/3 good response

1/3 some response

1/3 poor response

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15
Q

What are some of the significant adverse affects associated with antipsychotics?

A

Tardive Dyskinesia (involuntary muscle movements)

Neuroleptic malignant syndrome (muscle rigidity, altered mental status, autonomic instability, elevated WBC, CPK and LFTs)

Extrapyrimidal side effects

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16
Q

What are some of the extrapyrimdal side effects that may be noticed when taking antipsychotics?

A

Acute dystonia

Parkinson syndrome

Akathisia (inner restlessness and mental distress)

17
Q

What are some pharmacological agents to help with the extrapyrimidal side effects seen when taking antipsychotics?

A

Anticholinergics

Dopamine facilitators

Beta-blockers

18
Q

What is the most common symptom of psychosis? What does this mean pharmacologically?

A

Lack of insight

Patients won’t be compliant with drugs and will relapse. Estimated only around 30% of patients are compliant

19
Q

After around the third episode of schizophrenia what tends to occur? How can this be combatted?

A

After about 3 epiodes there is a significant decline in cognitive functioning, IQ, and increased presence of negative symptoms in the patient

Consider a long acting intramuscular antipsychotic (can be taken monthly / 3 monthly)

20
Q

In general what tend to be the side effects of typical antipsychotics?**

A

Extrapyrimidal symptoms

akathesia

tardive dyskenesia

21
Q

In general what tend to be the side effects of Atypical antipsychotics?**

A

Metabolic effects:

  • weight gain
  • hypercholesterolaemia
  • hyperglycemia
22
Q

Treatment resistant psychosis?

A

CLOZAPINE

23
Q

What are anxiolytics?

A

Used to treat anxiety disorders and substance misuse disorders

Often used in combination with SSRIs and SNRIs for anxiety disorders

24
Q

What are benzodiazepines used to treat?

A

Insomnia

Parasomnia

Alcohol withdrawal

Anxiety disorders

25
Q

What are some of the side effects of benzodiazepines? (eg. Diazepam)

A 
Somnolence (sleepiness)
Cognitive deficits 
Amnesia 
Disinhibition
Tolerance 
Dependence**

Psychiatry (19 decks)

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