Schizophrenia & Antipsychotics

Question 1

List some positive symptoms of schizophrenia

Answer 1

1. Delusions
2. Hallucinations (patient say they hear voices)
3. Abnormal (aggressive) behaviour
4. Thought disorder including feeling that thoughts are controlled by an outside agency

Question 2

List some negative symptoms of schizophrenia

Answer 2

1. Withdrawal from social contacts
2. Flattening of emotional responses
3. Depressive symptoms - loss of motivation

Question 3

Name at least 2 of the 4 TYPICAL antipsychotics

Answer 3

• Chlorpromazine (first antipsychotic drug)
• Haloperidol
• Fluphenazine
• Trifluoperazine

Question 4

Name at least 2 ATYPICAL antipsychotics

Answer 4

1. Amisulpride **
2. Clozapine **
3. Olanzapine
4. Risperidone

Question 5

Which type of receptor when antagonised, will result in dry mouth, constipation and blurred vision?

Answer 5

Muscarinic

Question 6

Which type of receptor when antagonised, will result in sedation and weight gain?

Answer 6

Histamine H1 receptors

Question 7

Which type of receptor when antagonised, will result in postural hypotension and dizziness?

Answer 7

Alpha adrenoreceptors

Question 8

Differentiate between pyramidal and extrapyramidal pathway

Answer 8

Pyramidal is the output from the primary motor cortex via the MEDULLA OBLONGATA

Extra pyramidal involves the basal ganglia, including the striatum and substantia nigra

Question 9

Name the 2 extrapyramidal side effects of anti psychotic drugs

Answer 9

1. Acute dystonias - Parkinsonism-like syndrome (cogwheel rigidity and tremor at rest)
2. Tardive (means slow development) dyskinesia (repetitive involuntary movements of the face, tongue and limbs) and akathisia (involuntary movements associated with restlessness, anxiety and agitation)

Question 10

Name the extrapyramidal side effect of anti psychotic drug that is REVERSIBLE

Answer 10

Acute dystonia - Parkinsonism symptoms (cogwheel rigidity and tremors)

If drug is stopped, these symptoms can be reversed

Question 11

Name the extrapyramidal side effect of anti psychotic drug that is IREVERSIBLE

Answer 11

Tardive dyskinesia and akathisia

Aka gradual development of involuntary movements of the face, tongue, limbs associated with restlessness, anxiety and agitation.

Irreversible because:
- The drug is an antagonist at the receptor
- Over time, the dopamine pathway adapts and becomes super sensitive/upregulated
- Body gets over stimulated by dopamine

Question 12

Differentiate between a typical and atypical anti psychotic drug.

Explain the difference

Answer 12

Atypical has LESS SEVERE extrapyramidal side effects (dystonia, dyskinesia, akathisia).

Atypicals have greater affinity for 5-HT2 and D4 receptors than typicals.

Question 13

Name a atypical drug associated with a particular severe adverse effect

Answer 13

Clozapine

Agranulocytosis

Question 14

What is the most severe side effect of clozapine to take note of?

Answer 14

Agranulocytosis

Question 15

List some side effects of clozapine (HINT: what are the receptors it antagonises)

Answer 15

Muscarinic: dry mouth, constipation, blurred vision

H1 antihistamine: sedation, weight gain

Alpha adrenoreceptors: postural hypotension and dizziness

Question 16

What is the unique side effects of amisulpride that sets it apart from the other atypicals?

Answer 16

Will not have the typical anticholinergic, antihistaminergic and alpha adrenoreceptor related symptoms as per the rest of the atypicals.

However, amisulpride is known to INCREASE PROLACTIN SECRETION -> gynaecomastia in males and breast swelling in females

Question 17

Name the 3 atypical antipsychotic drugs that can induce hyperglycaemia, diabetes and weight gain

Answer 17

Clozapine
Olanzapine
Risperidone

Question 18

Which is the only atypical antipsychotic that 1. not know to cause diabetes and 2. does not have the typical anticholinergic, histamine and alpha adrenoreceptor related side effects?

Name its adverse effect

Answer 18

Amisulpride

Known to increase prolactin secretion -> breast proliferation