Week 9- Psychosis and Movement Disorders Flashcards
What is the pattern in AD
Memory impairment , possible with expressive defects and deficits in complex executive function with preserved attention and visuospatial
What is the difference between pyramidal and extra-pyramidal symptoms
Pyramidal: spasticity and weakness
Extrapyramidal: no overt weakness, rigidity, hypo/hyperkinesia
rule of thumb: more dopa –>
direct pathway, more movement
anxiety makes all tremors….
worse…adrenalin sensitizes the muscle spindle
Differentiate essential tremor and parkinson’s tremor
Essential: PD
- head voice can be affected: uncommon for head to be affected
- symmetric: assymmetric
- maybe cogwheeling: rigidity
- large writing: micrographia
- better when walking: worse when walking
- better with EtOH: no change with EtOH
Parkinson’s tremor is a ____________
rest tremor, disappears with intention!!
early signs of PD
anosmia, depression, sleep disturbance, masked facies, stiffness, decreased arm swing, constipation
Sinemet is:
What does the therapeutic window do as disease progresses?
carbadopa + levodopa (carbadopa reduces the peripheral breakdown of levodopa)
narrows
Treatment of essential tremor
propranolol or primidone (anticonvulsant)
Treatment of chorea, tics and ballism?
An antidopaminergic drug (e.g. tetrabenzine or haloperidol
What are the four dopamine pathways and which are responsible for psychotic symptoms?
- Mesocortical ( less dopa here …negative symptoms like flat affect, ahedonia)
- Mesolimbic (more dopa here…positive symptoms)
- Nigrostriatal (basal ganglia communication)
- Tubuloinfundibular (inhibits prolactin)
antipsychotics….how they work, and broad side effect profiles
Variable blockade of:
- D2
- H1
- alpha1
- M1
- 5HT2a (for atypical)
S/E can be grouped into metabolic (from blocking H1…) and extrapyramidal-ish (EPS symptoms
Atypicals are “better” because they antagonize 5-HT2a. 5-HT2a physiologically slows dopa release. Blocking 5-HT2a then will increase dopa release, but the trick is that there are more of the receptors in the mesocortex so they treat the negative symptoms well without exacerbating the negative symptoms.
APs treat and AAPs treat
positive symptoms, negative symptoms
All APs are ______efficacious except _______
equally…sort of…it doesn’t appear that one is better than the next…. except clozapine, but this one is associated with agranulcytosis
treatment of neuroleptic side-effects
- acute dystonia
- pseudo-parkinsonism
- akathisia
- tardive dyskinesia
- neuroleptic malignant syndrome
- agitation
- insomnia
- persistent aggression
acute dystonia: anticholinergic
pseudo-parkinsonism: anticholinergic
akathisia: beta-blocker
tardive dyskinesia: STOP anticholinergic
neuroleptic malignant syndrome:
agitation
insomnia: benzos
persistent aggression: mood stablizer
Contrast actions of dopa and serotonin
Dopa: reward, pleasure, motor fine tuning, compulsion, perseveration
5-HT: mood, memory, sleep, cognition…akathisia is too much 5-HT?
S/S of the serotonin syndrome!
rigidity, myoclonic, hyper-reflexic, vasomotor instability, confusion, disorientation
What is catatonia?
marked decrease in reactivity to environment
To know:
- delusion disorder (1 month)
- brief psychotic disorder (1 day- 1 month)
- schizophreniform (1 month-6 months)
- schizophrenia (>6 months)
- Schizoaffective (at least 2 weeks of schizophrenic symptoms alone + mixed/manic/depressed episode)
- due to another condition
- Substance use disorder psychosis
- attenuated psychotic
What are the negative symptoms
- alogia (poverty of speech)
- Anhedonia
- Asociality
- Avolition (decreased purposeful behavior)
- Affective blunting
The neurotransmitter psychosis hypotheses
dopa
5-HT (increased activity…5-HT regulates dopamine tone)
glutamate (decreased transmission or NMDA function)
ACh-Da imbalance
What is the neurodevelopmental hypothesis?
neuronal changes occur while the brain is developing. Limited evidence for continued degeneration
Monozygotic concordance with schizophrenia, bipolar, MDD, panic
Schizo: 50
Bipolar: 70
MDD: 35
Panic: 25
All of the following are associated with basal ganglia lesions except…. intention tremor ( but abnormal postures is ass. with basal ganglia)
The cerebellar hemispheres are involved in learned and skilled motor activities, with the major output originating in the dentate nucleus and projecting to the VL/VA nuclei of the thalamus via the dentatorubrothalamic tract.
lateral hemispheres…
Most prominent imaging based finding in schizophrenia
ventricular dilatation (not decreased hippocampal volume, although this also happens)
The A in TRAP stands for….
Akinesia…not ataxia. people with PDs don’t usually get ataxia
