PHARMACOTHERAPY OF PSYCHOSIS & MANIA

Question 1

Prototypic disorder for 
understanding the 
phenomenology of 
psychosis & the impact of 
antipsychotic treatment

Answer 1

Schizophrenia

Question 2

exhibited
antipsychotic properties by decreasing
dopaminergic neurotransmission

Answer 2

Reserpine (Rauwolfia)

Question 3

exerted its effects through
depletion of monoamines from
presynaptic nerve terminals

Answer 3

Reserpine (Rauwolfia)

Question 4

reinforced by the high risk for 
drug-induced psychosis among 
substances that directly increased 
synaptic dopamine availability, 
including cocaine, amphetamines, 
& the Parkinson's disease 
treatment L-dopa

Answer 4

Dopamine theory of psychosis

Question 5

Basis for typical or first-generation antipsychotics

Answer 5

The dopamine (DA) overactivity hypothesis

Question 6

These medications differed in potency, 
but shared the common mechanism of 
significant DA D2
 blockade & associated 
risk for extrapyramidal side effects.

Answer 6

typical or first-generation antipsychotics

Question 7

Alternatives (non-dopaminergic) explored

Answer 7

Clozapine

Question 8

Potently antagonize the 5-HT2
receptor, while blocking D2
 receptors 
less potently than older typical 
antipsychotic agents

Answer 8

Nondopaminergic antipyschotics

Question 9

Results in the atypical clinical profile
of antipsychotic efficacy with limited
extrapyramidal side effects.

Answer 9

Nondopaminergic antipyschotics

Question 10

The effectiveness of dopamine D2
antagonists for the positive symptoms of
psychosis seen in most psychotic disorders
suggests a common etiology for these
symptoms related to excessive
dopaminergic neurotransmission in
_______________.

Answer 10

mesolimbic dopamine

pathways

Question 11

The psychoses related to delirium 
& dementia, particularly AD, may 
share a common etiology: 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ , 
either due to anticholinergic 
properties of medications.

Answer 11

the deficiency in cholinergic

neurotransmission

Question 12

Among hospitalized elderly patients, increased
plasma concentrations of anticholinergic
medications are directly associated with increased
__________.

Answer 12

delirium risk

Question 13

In varicosities (“terminals”) along terminal
arborizations of dopaminergic neurons
projecting from midbrain to forebrain, ______ is
synthesized and stored in vesicles.

Answer 13

dopamine

Question 14

Activation of the Gi
pathway can also activate K+
channels, leading to ___________.

Answer 14

hyperpolarization

Question 15

__________ inhibits the phosphatase
that liberates inositol (I) from
inositol phosphate (IP).

Answer 15

Lithium

Question 16

can also inhibit
depolarization-evoked release of DA
and NE, but not 5-HT

Answer 16

Lithium

Question 17

tricyclic structure in which two benzene

rings are linked by a sulfur & a nitrogen atom.

Answer 17

phenothiazines

Question 18

have a carbon in place of the nitrogen at
position 10 with the R1
moiety linked through a double
bond.

Answer 18

thioxanthenes

Question 19

Substitution of an electron-withdrawing group at
_______ increases the antipsychotic efficacy of
phenothiazines (e.g., chlorpromazine). The nature
of the substituent at _______ also influences
pharmacological activity.

Answer 19

position 2

position 10