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50 Cards in this Set
- Front
- Back
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Thorazine
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chlorpromazine
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Serentil
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mesoridazine
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Haldol
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haloperidol
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Navane
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thiothixene
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Prolixin
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fluphenazine
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Stelazine
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trifluoperazine
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Loxitane+
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loxapine
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Trilafon
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perphenazine
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Mellaril
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thioridazine
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Clozaril
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clozapine
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Geodon
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ziprasidone
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Seroquel
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quetiapine
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Zyprexa
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olanzipine
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Risperdal
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risperdone
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Abilify
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aripiprazole
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Positive Symptoms of Schizophrenia
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hallucinations, delusions, agitation
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Negative symptoms of Schizophrenia
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emotional and social withdrawal, blunted affect, impoverished thought and speech
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Brain abnormalities associated with Schizophrenia
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1. Enlarged ventricles
2. Limbic abnormalities 3. Other cellular abnormalities |
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Aspects of Enlarged ventricles in reference to Schizophrenia
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--static, not progressive
--not all people with schizophrenia show this —some posit a developmental (viral) origin |
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Aspects of limbic abnormalities in reference to Schizophrenia
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—cellular disorganization in the hippocampus
--abnormalities in entorhinal cortex, parahippocampal area and cingulate cortex |
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Aspects of other cellular abnormalities in reference to Schizophrenia
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--shrinkage of vermian region of cerebellum
—Thicker corpus callosum --brain structure differences due to developmental abnormalities: rearrangement due to abnormal synapse elimination, abnormal neuronal migration in frontal area in utero --accelerated loss of gray matter in adolescence |
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Main hypothesis of schizophrenia
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Hypofrontality hypothesis
Dopamine hypothesis Psychotogen hypothesis Integrative model |
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Evidence for Hypofrontality hypothesis of schizophrenia
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--resting activity lower in frontal lobes
—less activation with challenging tasks --related to prominent negative symptoms |
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Evidence for Dopamine hypothesis of schizophrenia
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1) amphetamine psychosis (phenylethylamine?)
2) effects of phenothiazines: post-synaptic D2 antagonists 3) Parkinson's disease |
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Evidence against Dopamine hypothesis of schizophrenia
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1) Some do not respond to phenothiazines
2) Many do respond to clozapine, which affects serotonin (5HT2A receptors)and dopamine (D2 receptors) 3) Little correlation between time drugs affect receptors and time behavior changes |
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Evidence for Psychotogen hypothesis of schizophrenia
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a. Defects in transmethylation (but actual behavioral effects of such substances do not look like schizophrenia)
b. PCP produces a very schizophrenia-like psychosis by affecting glutamate transmission on NMDA receptors |
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What five symptom dimensions of schizophrenia are affected by medication
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1. Positive symptoms
2. Negative symptoms 3. Cognitive symptoms 4. Aggressive and hostile symptoms 5. Depressive and anxious symptoms |
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Four key dopaminergic pathways in schizophrenia
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1. Mesolimbic from ventral tegmental area to limbic areas, such as nucleus accumbens
2. Mesocortical from ventral tegmental area to higher cortex 3. Nigrostriatal from substantia nigra to basal ganglia—extrapyramidal motor system 4. Tuberoinfundibular pathway from hypothalamus to anterior pituitary |
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Primary mechanism for Conventional Antipsychotic drugs
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D2 Blockade
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What does a D2 blockade in the mesolimbic pathway do?
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acts to reduce positive symptoms
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What does a D2 blockade in the mesocortical do?
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increases negative symptoms
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What does a D2 blockade in the nigrostriatal do?
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Produces EPS, long-term, up-regulation of D2 receptors produces tardive dyskinesia, which may become irreversible
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What does a D2 blockade in the tuberinfundibular do?
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hyperprolactinemia
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What other (non-D2 related) side effects are there with conventional anti-psychotics?
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a. Blockade of muscarinic Ach receptors cause anticholinergic side effects
b. Blockade of H1 receptors produce weight gain and drowsiness e. Blockade of alpha1 adrenergic receptors cause dizziness, drowsiness and decreased blood pressure |
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What makes an anti-psychotic atypical?
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a. 5HT2A and D2 antagonist
b. Fewer EPS c. Positive symptoms improve as much as for typical drugs |
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What are the effects of an atypical anti-psychotic in the nigrostriatal pathway?
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a. serotonin pathway is from raphe to substantia nigra and basal ganglia
b. 5 HT axons from raphe synapse on both dendrites and cell bodies in substantia nigra c. There are also axoaxonic terminals, and some diffusion of 5HT d. Either way, 5HT2A receptors on the DA neuron inhibit DA release, so inhibiting them reverses blockade of D2 receptors thus few or no EPS effects in the "tug-of-war" |
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What are the effects of an atypical anti-psychotic in the Mesocortical pathway?
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a. More 5HT2A receptors in this area than D2 receptors, by far
b. Blockade of the 5HT2A receptors thus "wins" in causing more D2 release than is stopped by the D2 blockade c. Result is fewer negative symptoms |
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What are the effects of an atypical anti-psychotic in the tuberoinfundibular pathway?
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serotonin acts as a releasing hormone for prolactin, so effects cancel each other out
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What are the effects of an atypical anti-psychotic in the mesolimbic pathway pathway?
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the D2 blockade is not affected as much because the 5HT2A blockade is not as total as in other pathways.
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Actions of Clozapine
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a. Few or no EPS, no tardive dyskinesia, prolactin not elevated
b. Does cause agranulocytosis, increased seizure risk, sedation and weight gain; some are of unknown cause, some due to 5HT2C, H1 or Ml binding. |
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Actions of Risperidone
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a. May get EPS at high doses, and it does elevate prolactin; less weight gain because no H1 blockade
b. Very effective for positive symptoms, good for negative symptoms, and for agitation and mood for other disorders as well, and possibly cognitive functioning. |
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Actions of Olanzipine
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a. No EPS, somewhat sedating, causes weight gain (Hi, 5HT2C), little tardive dyskinesia.
b. Effective for positive and negative symptoms, mood, cognitive functioning |
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Actions of Quetiapine
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a. No EPS, no prolactin elevation, may cause weight gain (H1)
b. Effective for positive, negative, mood and maybe cognitive functioning |
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Actions of Ziprasidone
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a. No EPS, no prolactin elevation, little weight gain; affects both serotonin and norepinephrine reuptake
b. Effective for positive, negative, maybe cognitive; mood effects not yet known. |
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Actions of Loxapine
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an SDA, but acts like a typical antipsychotic, except maybe at much lower doses
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Actions of Aripiprazole
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partial agonist of both D2 and 5HT1A receptors: effect is to reduce DA activity when there is excess, and increase it when there is not enough. Some adrenergic and histamine activity. Not used for elderly because of increased mortality and cardiovascular side effects.
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What system is involved in the metabolism of antipsychotics?
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CYP450 system
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What are the diversity issues associated with African American populations and Schizophrenia?
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1. Often treated with depot medications, higher doses and perceived as dangerous.
2. More likely to develop tardive dyskinesia, especially if affective disorder also present. 3. "Benign leucopenia"—normal white blood counts below "average," so MD's reluctant to prescribe clozapine. 4. Other atypical antipsychotics have fewer problems. |
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What are the diversity issues associated with Hispanic populations and Schizophrenia?
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1. Significantly lower doses than for Caucasians often prescribed—probable effects of environment and diet for typical antipsychotics.
2. Lower doses of atypicals also needed, response is faster, but also more side effects. |
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What are the diversity issues associated with asian populations and Schizophrenia?
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1. Generally need lower doses of both typical and atypical antipsychotics due to slower metabolism.
2. May have higher risk of acute dystonias, but lower risk of TD, due to lower doses. |
