Psychiatry

Question 1

The 4 Dopaminergic tracts

Answer 1

1. Nigrastriatal
2. Mesolimbic
3. Mesocortical
4. Tuberoinfundibular

Question 2

Which drug is the only one that helps with negative effects of schizophrenia?

Answer 2

Clozapine

Question 3

Which drug is the only one that helps with negative effects of schizophrenia?

Answer 3

Clozapine

Question 4

Which antipsychotic has the greatest risk of EPSE?

Answer 4

Haloperidol

Question 5

When do you normally see clozapine induced myocarditis?

Answer 5

Within 12-18 weeks. Beyond that, it is very unlikely to be clozapine induced.

Question 6

When does cardiomyopathy occur post clozapine?

Answer 6

Occurs from 4+ months from initiation.

Question 7

Clozapine metabolism is increased by smoking. What to do as an inpatient

Answer 7

If patient stops smoking and goes onto patch or not, reduce cloZapine by a quarter.

Question 8

Best drug for bipolar in pregnancy

Answer 8

Lithium - but needs fetal echo, level 2 ultrasonography and regular lithium monitoring.

Lamotrigine - safe but not very effective in mania.

Question 9

Which neurotransmitter is lowered in antipsychotics?

Answer 9

All antipsychotics lower dopaminergic transmission.
Second generation antipsychotics have additional properties of 5-HT2a antagonism, fast dissociation from D2, 5-ht1a agonism.
Aripiprazole had partial D2 agonism

Question 10

Which dopamine pathways are related to schizophrenia symptoms (e.g positive symptoms and negative symptoms).

Answer 10

Positive symptoms are associated with over activity of Mesolimbic pathway. Negative symptoms and cognitive symptoms are related to mesocortical pathway.

Question 11

Antipsychotics side effects types
1. Acute dystonia
(Duration, description, treatment)

Answer 11

Rapid onset (hours to days), sustained muscle contraction, treat with Bentropine or diphenhydramine

Question 12

Antipsychotics side effects
1. Akathisia (duration, description, treatment)

Answer 12

Days to weeks onset, feeling of inner restlessness. Treat with Beta blockers, benzos, Benztropine.

Question 13

Antipsychotics side effects
3. Parkinsonism (onset, description, treatment)

Answer 13

Onset: weeks to months
Treatment: benztropine, amantadine

Question 14

Tardive dyskinesia (onset, description, treatment)

Answer 14

Onset: >6 months
Repetitive muscle contraction
Treatment: valbenazine, tetrabenzine, clozapine