Psychopath lecture 2 Flashcards by Cutler Frandsen

What are the physical findings in a person with Schizophrenia?

Enlarged ventricles

- Changes in prefrontal cortex perfusion

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What is the neurochemistry of Schizophrenia?

Dopamine related phenomenon with too much stimulation of the D2 receptors
5HT (serotonin)/glutamate
Nicotine

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What is the genetic predisposition of Schizophrenia?

1% of population have schizophrenia

If one identical twin has schizo, then the other twin has a 40-50% chance
Environment plays a role, there seems to be a link between influenza during pregnancy leading to schizophrenia

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What are the pharmacological treatments for schizophrenia?

Block D2 receptors (typical antipsychotics)(D2 antagonist)

- Block 5HT2 receptors (atypical antipsychotics)

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What are the clinical benefits of schizophrenia treatment?

Reduce psychotic symptoms
Enhance cognition and executive functioning
Alleviate depression

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What are the social benefits of schizophrenia treatment?

-Made outpatient management of these patients possible

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What are the side effects of schizophrenia treatment from a D2 receptor blocker?

Orthostatic hypotension
Sedation
Xerostomia
Extrapyramidal side effects (Parkinson-like)

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What are the side effects of schizophrenia treatment from the atypical antipsychotics (5HT2 receptor blockers)?

Severe agranulocytosis

- Fewer side effects

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What are the extrapyramidal side effects the antipsychotics can cause?

Tardive dyskinesias

- Parkinson’s like tremors

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What are the psychologica/physical effects of antipsychotics?

Sleepiness
Restlessness
Disrupt endocrine
Can cause pseudo-depression
weight gain

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What are phenothiazines?

Typical Antipsychotic drug
Chlorpromazine
Thioridizine

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What causes the weight gain from phenothiazines?

-Anticholinergic effect

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Which class of antipsychotics have less extrapyramidal side effects?

-Phenothiazines

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What are Butyrophenones?

Typical Antipsychotic drug

- Haloperidol (Can cause tardive dyskinesias)

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What antipsychotic drug class has high extrapyramidal side effects?

-Butyrophenones

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What do atypical antipsychotic drugs block?

D2 receptors

- 5HT2A receptors

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What class of antipsychotic drugs are more effective against negative symptoms of schizophrenia?

-Atypical antipsychotics

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What is Clozapine?

-Atypical antipsychotic drug

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What can Clozapine cause?

-Serious agranulocytosis

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What is Quetiapine (Seroquel)?

-atypical antipsychotic

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What is Olanzepine (Zyprexa)?

-atypical antipsychotic

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What are atypical antipsychotic drugs??

Clozapine
Quetiapine
Olanzepine

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What is acute psychotic disorder?

It is Temporary schizophrenia type and situation dependent

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What is Schizoaffective?

Schizophrenia and depression

- Schizophrenia and mania

What is the background of mood disorders?

- 5% | - Depression and mania are the two sides of mood disorders

In mood disorders can mania present by itself?

-Not typically, depression can but mania is typically coupled with depression

What is the usual affective process of Mood disorders?

- Sadness - Simple unhappiness - Grief - Bereavement

What are the minor affective disorders of mood disorders?

- Depression-dysthymia | - Cyclothymia

What is depression-dysthymia?

- Last longer than 2 years - Can function though - Do not respond well to drugs - Female dominant

What is cyclothymia?

- Minor bipolar that lasts longer than 2 years - don't medicate - Need behavior management

What two things do you see in mood disorders?

- Manic | - Depression

What are the subtypes of Major depression?

-Postpartum

Major depression has variable expressions, what are they?

- Profound to Vegetative | - May have several episodes throughout life

When does postpartum show up?

1-4 weeks after delivery

What is SADS?

-Season Affective Disorder Syndrome

When are some common features of the treatment for major depression?

- Delayed onset (it takes a little while to work) | - 70% effectiveness

What are the drug categories to treat Major depression?

- Monoamine Oxidase Inhibitors | - Tricyclic antidepressants

What was the 1st modern antidepressants?

-Monoamine Oxidase Inhibitors

What are the side effects of Monoamine Oxidase Inhibitors?

- Alter autonomic system activity - Orthostatic hypotension - Weight gain

What do MAOIs do?

-increase 5HT, DA, NE

What might monoamine oxidase inhibitors interact with?

- foods that contain tyramine such as cheeses and beer | - OTC cold decongestants

What are two examples of MAOI's?

- Phenelzine | - Selegiline

What are the characteristics of tricyclic antidepressants?

- Long half life/single daily dose | - Block the uptake of NE and varying affinity for 5HT transporter

What are the side effects of Tricyclic antidepressants?

- Dry mouth (anticholinergic effect) - Histamine blockade - Orthostatic hypotension - Withdrawal with abrupt discontinuation

What are examples of tricyclic antidepressants?

- Amytriptyline - Desipramine - Doxepin

What do monoamine uptake blocker work on?

- 5HT - NE - DA

What are the properties of monoamine uptake blockers?

- Better tolerated - Mixture of selectivity - Minimal withdrawal

What do 5HT (SSRIs) cause for side effects?

- GI upset - Sexual dysfunction - Depression in adolescents - Headaches - Can cause weight loss)

Is there anticholinergic activity in SSRIs?

-No

What are the SSRI drugs?

- Fluoxetine (prozac) | - Sertraline (Zoloft)

What are the NE or mixed transport blocker drugs?

- Venlafaxine (effecxor) | - Duloxetine (Cymbalta)

What is bipolar referred to as?

-Manic/Depressive

What are the types of bipolar?

- Cyclothymia (mild type) | - Major manic depressive

What is major manic depressive?

- The mania can cause major compromised function - Poor decision making abilities - Impulsivity - Unrealistic

What are the medications used to treat Bipolar disorder?

- Lithium carbonate | - Antiepileptic drugs

What antiepileptic drugs are used to treat bipolar?

- Valproic acid - Carbamazepine - Lamotrigine

What are the general properties of lithium carbonate?

- Slow onset - Alters 2nd messenger systems - Often Combined with an antidepressant - Potent mood stabalizers

What are the side effects of lithium carbonate?

- Narrow therapeutic window - Tremors common - Potential kidney damage - Weight gain - Edema - High rate of compliance problems

What are the biological theories of mood disorders?

- Catecholamine theory | - imbalance of DA, NE, or 5HT activity