Psychopharmacology - Schizophrenia

Front 1

Which parts of the brain tend to be smaller in schizophrenic patients?

Back 1

*frontal/prefrontal regions
*anterior hippocampus - directly related to degree of cognitive decline
*overall reduced weight

Front 2

What metabolic changes are seen in schizophrenia?

Back 2

Reduced metabolism in the prefrontal region, especially the left hemisphere when trying to solve problems

Front 3

What differences in dopamine levels are seen in schizophrenia?

Back 3

* too much Da in the left amygdala
* too little Da and Ach in the left basal ganglia

Front 4

What parts of the brain show microscopic differences in schizophrenia?

Back 4

Hippocampus, cortex, thalamus

Front 5

Schizophrenia involves defective neuronal migration - in which part of the brain?

Back 5

Hippocampus

Front 6

What 3 problems occur in neurons in schizophrenia?

Back 6

1. reduced size
2. reduced synapses
3. reduced # of dendritic spines

Front 7

Which 5 chromosomes have been implicated in schizophrenia?

Back 7

5, 6, 8, 11, and 22

Front 8

What are the concordance rates for schizophrenia among MZ twins? Parents and siblings? No relationship?

Back 8

MZ twins: 50%
Parents/siblings: 10%
No relationship: 1%

Front 9

Maternal infection during the ____ trimester is a risk factor for schizophrenia

Back 9

2nd trimester

Front 10

Which 4 NT systems are impacted by schizophrenia?

Back 10

1. Dopamine
2. Serotonin
3. Glutamate
4. GABA

Front 11

How is the dopamine system impacted by schizophrenia? Which receptors are involved?

Back 11

1. overactivity in the limbic system - increased sensitivity of D2 receptors, associated with positive sx
2. underactivity in the prefrontal cortex - reduced D1 receptors, associated with negative sx

Front 12

What are the consequences of too much/too little serotonin in schizophrenia?

Back 12

Too much 5-HT --> positive sx
Too little 5-HT --> negative sx

Front 13

Name 4 endocrine disorders that can cause psychosis and mania

Back 13

1. Addison's disease
2. Cushing's disease
3. Grave's disease
4. Myxedema

Front 14

Metabolic disorders that can cause psychosis and mania

Back 14

1. Major organ failure
2. Vitamin deficiency - esp B vitamins
3. Hypoglycemia
4. Phorphyria
5. Pancreatitis
6. Hypoxia
7. Fluid/electrolyte imbalance

Front 15

Neurological disorders that may cause psychosis and mania

Back 15

1. Brain infections or encephalitis
2. Tumors, esp. of temporal lobes
3. Neurodegenerative d/o - Alzheimer's, Parkinson's, Huntington's, MS - usually in mid-late phases

Front 16

Substances/drugs that can cause psychosis and mania

Back 16

1. Stimulants
2. Hallucinogens
3. PCP, etc.
4. Opioids
5. Steroids
6. L-Dopa
7. Anticholinergics
8. Alcohol (withdrawal)

Front 17

Name one butyrophenone antipsychotic

Back 17

Haldol/haloperidol

Front 18

Name 2 dibensoxazepine antipsychotics

Back 18

Loxatine/loxapine
Moban/molindone

Front 19

Name 1 phenothiazine antipsychotic

Back 19

Thorazine/chlorpromazine

Front 20

Name 3 piperazine antipsychotics

Back 20

Prolixin/fluphenazine
Trilafon/perphenazine
Stelazine/trifluoperazine

Front 21

Name 3 piperidine antipsychotics

Back 21

Serentil/mesoridazine
Orap/pimozide
Mellaril/thioridazine

Front 22

Name 1 thioxanthene antipsychotic

Back 22

Navane/thiothixine

Front 23

When were many of the atypical antipsychotics developed?

Back 23

1990s

Front 24

What do atypical antipsychotics do differently than typicals?

Back 24

In addition to acting as D2 antagonists in the limbic system, newer agents act as 5HT2 antagonists in the prefrontal cortex

Front 25

What are the four major types of extrapyramidal side effects?

Back 25

1. Parkinsonism
2. Dystonias
3. Akathisia
4. Tardive Dyskinesia

Front 26

What are the peripheral side effects of anticholinergic drugs?

Back 26

dry mouth, eyes;
blurry near vision;
urinary retention and constipation; tachycardia;
decreased libido and sexual dysfunction

Front 27

What are the CNS side effects of anticholinergic drugs?

Back 27

delirium;
impaired memory, attention, and concentration

Front 28

What are the 3 main features of neuroleptic malignant syndrome (NMS)?

Back 28

1. Hyperthermia
2. EPS
3. ANS dysfunction

Front 29

What factors increase one's risk for tardive dyskinesia?

Back 29

1. high dose/low potency
2. long time taking meds
3. comorbid dx
4. pronounced negative sx
5. early onset EPS, EPS requiring comedication
6. Older; female; family history
7. Organic mental/brain d/o
8. Smoking/drinking
9. Diabetes

Front 30

About how long to antipsychotics take to reduce symptoms?

Back 30

between days and weeks - not immediate

Front 31

Name four anticholinergic drugs used to treat EPS (parkinsonism and dystonias)

Back 31

Cogentin/benztropine
Benadryl/diphenhydramine
Artane/trihexyphenidyl
Akineton/biperiden

Front 32

Describe the drug interactions between neuroleptics and most antidepressants

Back 32

most antidepressants inhibit the CYP450 enzymes needed to metabolize neuroleptics; results in elevated blood pressure

Front 33

Which drugs interact with older neuroleptics to cause reduced blood pressure?

Back 33

antacids, anticonvulsants, and nicotine induce metabolic action of CYP450

Front 34

What four substances can interact with older neuroleptics to cause extremely low blood pressure?

Back 34

1. Demerol/merperidine
2. Beta blockers
3. Other blood pressure meds
4. Alcohol