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16 Cards in this Set
- Front
- Back
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Schizo Symptoms
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(+): hallucinations (auditory), delusions of grandeur or prosecution, paranoia, illogical speech (rhyming). (-): reduced speech, inappropriate affect, avolition (loss of motivation), social withdrawal, anhedonia, lack of hygiene. Cognitive: impaired working memory + exec funx
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Dopa Hypothesis
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Positive symptoms due to D2 hyperactivity. Amphetamine + cocaine worsen symptoms. All antipsychotics block D2 receptors. Negative symptoms due to hypoactivity
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Glutamate Hypothesis
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PCP psychotomimetic blocks glutamate. Produces positive + negative symptoms. Suggests dyfunx glutamate receptors
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5-HT Hypothesis
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Hallucinogens activate 5-HTR. Newer antipsychotics block D2 and 5-HT2A to relieve positive + negative symptoms
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D2 Systems
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Mesolimbic - VTA to limbic, hyperactivity, pos. Mesocortical - VTA to cortex, hypoactivity, neg + cognitive deficits. Nigrostriatal - substantia nigra to striatum, motor. Tuberohypophyseal - hypothalamus to pituitary, PRL
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Typical Antipsychotics
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Low potency: aliphatic phenothiazines (chlorpromazine) and piperidine phenothiazines (thioridazine). High potency: piperazine phenothiazines (fluphenazine), thioxanthines (thiothixene), butyrophenones (haloperidol). Relieve pos symptoms
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Phenothiazine Chemistry
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Tricyclic with S bridge. Three Cs separate amine side chain from ring N ideally (2 Cs antihistamine). C2 methyl antihist in absence of X gr. OH renders inactive. X halogen, CF3, etc; H reduces activity. X in another/two positions renders inactive
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Thioxanthine (thiothixene) Chemistry
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Substitute C for aromatic N
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Typical Antipsychotic SEs
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Nigrostriatal EPS (esp high potency): acute dystonia (bizarre contractions), akinesia, Parkinsonism (dopa/ACh imbalance), akathisia (restlessness). Tuberhypophyseal: thermoregulatory (unclear) PRL inc (dec libido, gynecomastia, galactorrhea). Tardive dyskinesia due to supersensitive DA receptors (limiting). Anti-histamine sedation (esp. low potency, subsides). Anti-muscarinic anti-SLUDGE (esp. low potency). Alph antag ortho hypo (esp. low potency)
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Atypicals
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Block 5-HT2A and D2. Treat positive + negative symptoms. Lower incidence of EPS and TD
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Clozapine
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D4 > 5-HT2A > D2. Strong antimuscarinic (paradoxical hypersalivation, hyperglycemia, wgt gain, QT prolongation, dose-rel seizures), agranulocytosis limits. Worst atypical for sedation + autonomic fx
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Olanzapine
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Sim. to clozapine w/o agranulocytosis. Wgt gain, hyperglycemia, hypercholesterolemia. EPS at high doses. Clozapine + olanzapine worst atypical hyperglycemia + wgt gain
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Quetiapine
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Less effective neg symptom relief. Wgt gain, cataracts (regular eye exams)
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Ziprasidone
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Contraindicated with cardiac problems: can cause QT prolongation, arrythmias, sudden death. No wgt gain or hyperglycemia
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Risperidone
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Intermediate b/w atypicals + typicals. EPS at mod-high doses (worst atypical). Min. anti-muscarinic. 1st dose ortho hypo. Agitation may occur. Less wgt gain than others. Worst atypical PRL fx
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Aripiprazole
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Partial D2 + D3 agonist. Minor SEs: HA, agitation
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