Schizophrenia and Antipsychotic drugs

Question 1

Define Schizophrenia

Answer 1

schizo: split
phrenia: mind

“fragmented thinking”

Question 2

List active schizophrenia symptoms

Answer 2

• delusions
• hallucinations
• disordered thinking: paranoia
• inappropriate, bizarre behavior
• violence
• incontinence

Question 3

List passive symptoms of schizo

Answer 3

• withdrawal
• falt affect
• apathy
• no emotional response

Question 4

Incidence of schizo

Answer 4

2 million in US, half of which are likely treated

progressive deterioration of personality

Question 5

Describe etiology of schizophrenia

Answer 5

genetic and environmental component

evidence for excess activity of dopamine neurons in the CNS

Question 6

Antipsychotics / neuroleptics have been described as what?

Answer 6

major tranquilizers

Question 7

provide brief synopsis of history of antipsychotics and its effects

Answer 7

1952: chlorpromazine - 1st antipsychotic

• suppressed complex, but not reflex behaviors
• loss of initiative
• disinterest in environment
• decrease in emotion

Question 8

What are 3 common traits of of antipsychotics

Answer 8

• take days to weeks to be effective when given orally
• not addictive
• px do not become tolerant to antipsychotic effects

Question 9

Name the typical (1st gen) antipsychotics, whether or not they are high or low potency and MOA.

Answer 9

MOA: all work in part by blocking DA2 receptors in brain, strong affinity for D2 receptors, some affinity for histamine receptors

High potency:

• haloperidol
• pimozide

Low potency:

• chlorpromazine
• fluphenazine
• perphenazine
• prochlorperazine
• trifluoperazine
• thioridazine
• thiothixene

Question 10

What are the targets for the major tranqs?

Which target is most affected?

Answer 10

D2 receptors + H1 receptors + serotonin receptors

The D2 receptor is most significantly affected

Question 11

Name the “atypical” antipsychotics

Name two of these also used as antidepressants

Answer 11

aripiprazole
quetiapine

asenapine
clozapine
iloperidone
loxapine
lurasidone
olanzapine
paliperidone
risperidone
ziprasodone

aripriprazole and quetiapine are also used as antidepressants

Question 12

MOA and sites of action for antipsychotics?

Answer 12

MoA: inhibit dopaminergic neurons

Sites of Action: CNS and Autonomic system

Autonomic system effects: anticholinergic and antihistamine

CNS sites of action: cortical, basal ganglia, CTZ, anterior hypothalamus

Cortical: decrease delusions, decrease agitation, impair intellectual function

Basal ganglia: can cause extra pyramidal symptoms (movement disorders) and inhibit secretion of some hormones (GH and CRH)

CTZ (medulla oblongata’s chemoreceptor trigger zone): decrease nausea

anterior hypothalamus: lower body temperature

Question 13

List the 8 side effects of antipsychotics

Answer 13

1. extrapyramidal
   - due to D2 blockade
   - parkinson like symptoms: bradykinesia
   - tremor
   - akinesia
   - dystonias: movements of head, tongue, facial muscles, neck, blepharospasm
   - akasthisia: need for constant movement
   - tardive dyskinesia

(some of these can be reversed with anticholinergics)

2. sedation
   - mild, due to H1 blockade
3. postural hypotension
   - alpha-1 blockade
4. hypersensitivity reaction
   - rashes
5. alterations in visual system
   - anticholinergic effects
   - chlorpromazine causes deposition of metabolites in eye = irreversible lens pigmentation
6. endocrine disturbances
   - increased prolactin secretion
7. neuroleptic malignant syndrome
   - like malignant hyperthermia (fluranes, withdrawal from some Parkinson drugs)
8. dysphoria
   - don’t feel no bueno

Question 14

Do antipsychotics interact with other drugs?

Answer 14

yes, with CNS depressants

Question 15

Other uses of antipsychotics:

Answer 15

bipolar disorders
hiccups
nausea
Tourettes
OCD
stuttering
migraine