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Case 2: CNS > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

how is dopamine made

A

from amino acids (particularly tyrosine)

  1. tyrosine transporter transports tyrosine from bloodstream to neuron
  2. tyrosine hydroxylase (TOH) is enzyme that converts tyrosine to DOPA
  3. DOPA decarboxylase converts DOPA to dopamine (DA)
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2
Q

where does dopamine bind

A

to 5 types of postsynaptic receptors (D1-D5)

D2 = most significant because it acts as a negative feedback mechanism regulating release of dopamine from pre-synaptic neurone

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3
Q

3 enzymes involved in the break down of dopamine and it’s final breakdown product

A
  1. MAO, aldehyde dehydrogenase and COMT

Final product - homovanillic acid (HVA)

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4
Q

role of mesolimbic pathway

A

perception
addiction
pleasure and reward seeking behaviours
emotions

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5
Q

mesolimbic effect in psychotic symptoms

A

hyperactivity of of dopamine = positive psychotic symptoms

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6
Q

ideal drug action in mesolimbic pathway to treat psychosis

A

decrease DA
antagonism of D2 receptors

SE = reduction of pleasure effects
complete blockade = neurolepsis

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7
Q

role of mesocortical pathway

A 
cognition 
Attention 
memory 
emotional behaviour 
learning
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8
Q

mesocortical effect in psychotic symptoms

A

decreased dopamine = negative and depressive symptoms

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9
Q

ideal drug action in mesocortical pathway to treat psychosis

A

increase DA to treat -ve and cognitive symptoms

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10
Q

role of nigrostriatal pathway

A

movement and sensory stimuli

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11
Q

hyperactivity of dopamine in nigrostriatal pathway

A

hyperkinetic movement disorders

tics, dyskinesia and chorea

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12
Q

Symptoms caused by blockade of D2 receptors in nigrostriatal pathway

A

akathisia
dystonia
parkinsonian symptoms
long-standing blockade = tardive dyskinesia

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13
Q

ideal drug action in nigrostriatal pathway to treat psychosis

A

leave dopaminergic tone unchanged

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14
Q

tuberoinfundibular pathway role

A

regulates prolactin secretion by the pituitary gland

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15
Q

4 major dopamine pathways in brain

A

mesolimbic
mesocortical
nigrostriatal
tuberoinfundibular

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16
Q

blockade of D2 receptors in tuberoinfundibular pathway

A

hyperprolactinaemia which clinically manifests as:

  • sexual dysfunction
  • glactorrhoea (abnormal lactation)
  • amenorrhea (absence of menstruation)
  • infertility

long-term = association with osteoporosis

17
Q

ideal drug action in tuberoinfundibular pathway to treat psychosis

A

leave dopaminergic tone unchanged

18
Q

ideal drug action of anti-psychotic on all 4 dopamine pathways

A

mesolimbic - decrease DA (to treat +ve symptoms)
mesocortical - increase DA (to treat -ve and cognitive symptoms)
nigrostriatal - no effect
tuberoinfundibular - no effect

19
Q

side effects of muscarinic and cholinergic blocking antipsychotics

A

constipation
dry mouth
blurred vision
cognitive blunting

e.g. chlorpromazine

20
Q

examples of extra-pyramidal symptoms

A 
inability to sit still
involuntary muscle contraction
tremors
stiff muscles
involuntary facial movements
21
Q

3 stages of treatment for schizophrenia

A
  1. Acute phase
    - patient exhibits acute symptoms (+ve and -ve)
    - normally starts in hospital
    - patient is a danger to self and other
  2. Stabilisation phase
    - first 6 months after onset of acute phase
    - start to reduce symptoms
    - start antipsychotic
  3. Stable phase
    - remain on lowest effective dose to control symptoms
    - aim to integrate patient back into society
22
Q

negative symptoms of schizophrenia

A 
loss of emotional connectedness 
slow down of movements 
lack of socialisation 
loss of speech
lack of focus/engagement
loss of executive functions
23
Q

positive symptoms of schizophrenia

A 
hallucinations 
agitation
unusual behaviour 
delusions 
disorganised speech
24
Q

3 considerations when treating schizophrenia

A

smoking - marijuana and tobacco induces CYP1A2 which metabolises clozapine (suddenly stopping = higher clozapine conc in body)

if pregnant - take antipsychotic patient has most experience with

side effects - constipation, drooling and heart inflammation

25
Q

when is clozapine indicated

A

treatment resistant schizophrenia

severe, untreatable adverse reactions to other antipsychotic agents including atypical antipsychotics

26
Q

low potency 1st gen antipsychotics

A

chlorpromazine (sedative)

prochlorperazine and thioridazine

27
Q

high potency 1st gen antipsychotics

A

haloperidol (good sedative, quick onset of action and not recommended long-term)
fluphenazine, pimozide and thiothixene

28
Q

to monitor when patient using 2nd gen antipsychotics

A 
weight (BMI)
waist circumference 
BP 
fasting lipids 
fasting plasma glucose
29
Q

types of 2nd gen antipsychotics

A

‘rip’ and ‘pips’ - cariprazine, bre

Case 2: CNS (1 decks)

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