The Mind, Treatment Of Psychotic Disorders

Front 1

what is necessary and sufficient characteristic of an effective antipsychotic drug?

Back 1

D2 blockade is a necessary and sufficient characteristic of an effective antipsychotic drug

Front 2

what is haloperidol?

Back 2

antipsychotic with D2 blocakde effect

Front 3

what pathways should be blocked to alleviate positive symptoms?

Back 3

mesolimbic (feeling)

Front 4

blockade of what pathways would aggrevate negative or cognitive symptoms?

Back 4

mesocortical (thinking)

Front 5

in what area of the brain is dompamine an inhibitor of prolactin release?

Back 5

Tuberoinfundibular (endocrine) which tract between from hypothalamus to pituitary

Front 6

which pathway, when blocked, leads to the neurological symptoms seen with a high dosage of a D2 blocking medication (antipsychotic)?

Back 6

Nigrostriatal

Front 7

Clinical response occurs at what percentage of striatal D2 receptor blocking?

Back 7

65%

Front 8

Hyperprolactinemia occurs at what percentage of striatal D2 receptor blocking?

Back 8

72%

Front 9

Neurological symptoms occur at what percentage of striatal D2 receptor blocking?

Back 9

78%

Front 10

Describe the theapuetic window for antipsychotic drugs?

Back 10

Very normal with slightly increased doses leading to first hyperprolactinemia and the neurological symptoms

Front 11

describe inmprovements from the older typical antipsychotics to the newer atypical antipsychotics?

Back 11

the newer ones are really better for + symptoms, but tend to be better for negative symptoms (because of more selectivity in D2 blockade)

Front 12

which has a higher likelyhood of causing neurological symptoms? typical or atypical antipsychotics?

Back 12

typical

Front 13

which has a higher likelyhood of causing metabolic symptoms? typical or atypical antipsychotics?

Back 13

atypical

Front 14

what is the common interaction that all atypical antipsychotics share?

Back 14

5HT2a antagonism

Front 15

why is the 5HT2a antagonist effect of atypical antipsychotics beneficial?

Back 15

it causes increased dopamine release in areas where there are serotonin receptors which can offset the D2 blockage effects of antipsyochotics in the Nigrostriatal, and Tuberoinfundibular mesocortical pathways reducing negative symptoms and alleviating other side effects (EX Neurological effects and hyperprolactinemia)

Front 16

what is the most effective drug in the drug resistant, psychotic patient?

Back 16

clozapine

Front 17

which of the antipsychotics has the weakest D2 blockade?

Back 17

clozapine

Front 18

what two behavioral changes are seen in patients who undergo therapy with clozapine?

Back 18

1. reduced suicidality
2. reduced substance abuse

Front 19

why isnt clozapine a first line drug in the treatment of psychotic disorders?

Back 19

it has significant toxicity

Front 20

describe the unique pharmacology of aripiprazole?

Back 20

it is a partial agonist at D2 receptor thus it decreases activity of dopamine in dopamine rich areas (decreasing psychosis) and increases dopamine activity in dopamine poor areas (decreasing side effects)

Front 21

how long does it take an antipsychotic to show noticeable effects?

Back 21

weeks

Front 22

what effects to antipsychotics cause that can reduce that chronicity and severity of psychiatric disorders like schizophrenia?

Back 22

1. promote neurogenesis
2. neuroprotective/neurotropic

Front 23

what is the best way to improve the prognosis of someone with a psychiatric disorder (EX schizophrenia)?

Back 23

Get them on antipsychotic drugs ASAP

Front 24

what is a tardive syndrome (in reference to the use of antipsychotics)

Back 24

an extra-parametal symptoms (EPS) which starts late in treatment and may not regress after treatment is stopped

Front 25

what are the 3 types of acute EPS?

Back 25

1. Dystonic reaction
2. Parkinsonism
3. Akathisia

Front 26

which of the three types of acute EPS is described below?

is an acute-onset muscle spasm which may involve almost any muscle groups. Most notorious are those that involve back (opisthotonus) or neck (torticollis or retrocollis) muscles, extraocular muscles (oculogyric crisis), and even pharyngeal or laryngeal (which may be life-threatening) muscles

Assoc. w/ young age, male sex, IM Rx

Back 26

Dystonic reaction

Front 27

what is the best treatment for a dystonic reaction?

Back 27

anticholinergic

Front 28

which of the three types of acute EPS is described below?

may include muscle rigidity, tremor, bradykinesia, drooling, mask-like facies, and flattened affect.

Associated with older age, prior brain injury

Back 28

Parkinsonism reaction

Front 29

what is the DOC for a parkinsonism reaction (acute EPS) with a antipsychotic?

Back 29

Amantidine (anticholinergic)

Front 30

what acute EPS does the following describe?

is a state of motor restlessness that may be expressed subjectively (feeling unable to relax; impulsive feelings or behaviors) or objectively (fidgety or hyperactive motor behavior)

is the most common acute EPS

Back 30

akathisia

Front 31

what two drug classes can be used to alleviate symptoms of Akathisia (acute EPS)?

Back 31

1. Beta-blocker
2. Anticholingergic

Front 32

what are the three types of tardive syndromes?

Back 32

Tardive dyskinesia, akathisia, and dystonia

Front 33

what causes the formation of tardive syndromes

Back 33

D2 upregulation

Front 34

for every year of taking a typical (older generation)neuroleptic what is your risk for developing a tardive syndrome?

Back 34

4-5%

Front 35

what are the risk factors that increase the likelyhood of developing a tardive syndrome? (3)

Back 35

1. Age: elderly up to 10X risk
2. Sex: women > men (modest effect)
3. Mood disorders? Myth vs fact? Evidence base fuzzy

Front 36

what is the greatest risk factor for developing tardive dyskinesia?

Back 36

AGE AGE AGE :)

Front 37

describe the risk per year for atypical antipsychotics in developing a tardive syndrome?

Back 37

.5-1%

Front 38

which two atypical antipsychotics have almost no risk of tardive syndrome formation?

Back 38

1. Quetiapine
2. Clozapine

Front 39

Galactorrhea; breast swelling and tenderness; sexual inhibitions (desire, response)
are mediated by which effects of antipsychotic drugs?

Back 39

D2 blockade in the Tuberoinfundibular (endocrine) pathways

Front 40

These symptoms are most likely due to which syndrome caused by psychotic drugs?

Rigidity, hyperpyrexia, dysautonomia, mental status changes
Lab: Increased CK, WBC
Incidence 1-2%; mortality 5-20%

Back 40

Neuroleptic malignant syndrome

Front 41

which drugs are more likely to cause Neuroleptic malignant syndrome, first or second generation antipsychotics?

Back 41

first generation

Front 42

what are two drug therapies for Neuroleptic malignant syndrome?

Back 42

1. dantrolene - muscle relaxent
2. bromocriptine - dopaminergic

Front 43

what is the most effective treatment for Neuroleptic malignant syndrome?

Back 43

ECT

Front 44

what is the thing that must be monitered every week when taking an antipsychotic, esp. clozapine?

Back 44

CBC

Front 45

These 4 "black box" symptoms are indicative of cardiovascular side-effects of which antipsychotic drug?
1. agranulocytosis
2. seizures
3. myocarditis
4. orthostatic hypotension/respiratory depression, esp. if coadministered a benzodiazepine

Back 45

clozapine

Front 46

which antipsychotic is particulary associated with myocarditis?

Back 46

clozapine

Front 47

why do you tell patients taking antipsychotics to be very careful when outside on a sunny summer afternoon?

Back 47

antipsychotics cause photosensitivity, but more importantly it impairs thermoregulation which can cause them to get heat stroke much faster than a normal person

Front 48

most drug interactions of antipyschotics occur because of?

Back 48

actions upon metabolic enzymes (P450)

Front 49

what are two drugs that are general inducers of antipsichotic interactions?

Back 49

1. phenytoin
2. phenobarbitol

Front 50

what class (in regards to danger for developing fetus) are all antipsychotics?

Back 50

Class C - indicates there may be a small risk for use in pregnant women, but use anyway if benefit is large