Psychosis

What is the most common form of psychosis?

Schizophrenia is the most common form of psychosis.

What is the typical onset and duration of schizophrenia?

Schizophrenia typically has its onset in late adolescence and is a chronic, recurring life-long disorder.

What percentage of adults have a lifetime history of schizophrenia spectrum disorders?

Nearly 2% of adults have a lifetime history of schizophrenia spectrum disorders.

What are 'neologisms' in the context of schizophrenic symptoms?

Neologisms are a form of disorganized speech where a patient makes up new words.

Name one of the susceptibility genes mentioned for schizophrenia.

BDNF, Dysbindin, Neuregulin, or DISC-1 are susceptibility genes for schizophrenia.

Mutations in susceptibility genes like DISC-1 can result in abnormal development in which two life stages?

These mutations can result in abnormal pre- and post-natal brain development.

Abnormal transmission of which neurotransmitter is critical in the pathophysiology of schizophrenia, affecting synaptic plasticity, learning, and memory?

Abnormal glutamate transmission is a key factor.

Imaging studies in schizophrenia patients show malfunctioning neural circuits in which two brain areas?

The dorsolateral prefrontal cortex and the amygdala.

What structural brain abnormality regarding the ventricles is a neurobiological correlate of schizophrenia?

Enlarged ventricles are often observed in patients with schizophrenia.

Schizophrenia is associated with reduced blood flow to which two brain regions?

The caudate nucleus and the frontal lobes.

What neurobiological correlate of schizophrenia is observed in the hippocampus at a cellular level?

Cellular disarray in the hippocampus is associated with chronic schizophrenia.

The _ hypothesis of schizophrenia suggests that the disorder results from abnormal dopamine neurotransmission.

dopamine

What is the correlation between a drug's potency to block D2 receptors and its clinical effect in psychosis?

There is a good correlation between the potency to block dopamine (D2) receptors and the potency of antipsychotic efficacy.

Which older antihypertensive drug depletes dopamine storage and has antipsychotic effects, supporting the dopamine hypothesis?

Reserpine.

What effect do amphetamines have on dopamine that can induce psychotic-like symptoms?

Amphetamines trigger the release of dopamine.

Antipsychotics are effective in approximately what percentage of patients?

Antipsychotics are effective in about 70% of patients.

What is another term for antipsychotic drugs?

Neuroleptics.

Relapse occurs in what proportion of patients who stop antipsychotic drug treatment within 6 months to 1 year?

Relapse occurs in two-thirds (2/3) of patients who stop treatment within that timeframe.

What is the general mechanism of action for most antipsychotic drugs?

Most are dopamine receptor antagonists.

Haloperidol, Loxapine, and Chlorpromazine belong to which class of antipsychotics?

First-Generation Antipsychotics (FGAs).

Olanzapine, Risperidone, and Quetiapine belong to which class of antipsychotics?

Second-Generation Antipsychotics (SGAs).

Chlorpromazine is an FGA belonging to which chemical group?

Phenothiazines.

What is the mechanism of action of First-Generation Antipsychotics (FGAs)?

They are dopamine D1 and D2 receptor antagonists across the central nervous system.

Blockade of D2 receptors in which two brain areas is thought to lead to the therapeutic effects of FGAs on positive symptoms?

The mesolimbic and mesocortical areas.

FGAs are generally less effective against which type of schizophrenic symptoms?

Negative symptoms such as blunted affect, apathy, and social isolation.

Blockade of D2 receptors in the _ system by FGAs leads to Extra-Pyramidal Symptoms (EPS).

nigrostriatal

What are the three types of Extra-Pyramidal Symptoms (EPS) mentioned?

Akathisia, dystonia, and Parkinsonism.

What is tardive dyskinesia (TD)?

A motor disorder characterized by involuntary movements that can develop after long-term use of D2 receptor blockers.

What is the mechanism of action for Deutetrabenazine (Austedo) and Valbenazine (Ingrezza), drugs used to treat tardive dyskinesia?

They are selective Vesicular Monoamine Transporter 2 (VMAT 2) inhibitors.

What is the purpose of the Abnormal Involuntary Movement Scale (AIMS)?

To rate the presence and severity of involuntary movements, often used to monitor for tardive dyskinesia.

Blockade of D2 receptors in the tuberoinfundibular system by FGAs can lead to what hormonal change?

Hyperprolactinemia (increased prolactin).

What are three potential consequences of hyperprolactinemia caused by FGAs?

Gynaecomastia, galactorrhoea, amenorrhoea, or infertility.

In the nigrostriatal dopamine tract, what is the functional result of dopamine antagonism?

It can cause movement disorders, such as Extra-Pyramidal Symptoms.

In the mesolimbic dopamine tract, what is the functional result of dopamine antagonism?

Relief of psychosis.

What is the primary function of the tuberoinfundibular dopamine tract?

It regulates prolactin release from the pituitary gland.

Blockade of which receptor by FGAs can cause postural hypotension?

α-adrenoceptors.

Anticholinergic side effects like dry mouth and blurred vision from FGAs are caused by a blockade of which receptor?

Muscarinic receptors.

Blockade of which receptor by FGAs is responsible for sedation?

Histamine (H1) receptors.

Weight gain associated with some antipsychotics is linked to the blockade of which receptor?

5-HT (serotonin) receptors, specifically 5-HT2C.

Low-potency FGAs like chlorpromazine are associated with which three types of side effects?

Hypotension, sedation, and anti-cholinergic effects.

High-potency FGAs like haloperidol and fluphenazine are most likely to induce which major adverse effect?

Extra-Pyramidal Symptoms (EPS).

What is the primary mechanism of action for Second-Generation Antipsychotics (SGAs)?

They are inverse agonists at 5HT2A receptors with weaker D1, D2, and D4 receptor blockade.

Compared to FGAs, SGAs are thought to have a lower risk of which major side effect?

Extra-Pyramidal Symptoms (EPS).

Which two SGAs are particularly associated with a high risk of weight gain, obesity, and metabolic syndrome?

Clozapine and olanzapine.

The weight gain caused by SGAs like clozapine is linked to H1 and 5HT2C receptor blockade modulating eating centers in which brain region?

The hypothalamus.

For which specific patient population is clozapine typically reserved?

Patients with treatment-resistant psychosis.

Clozapine is associated with a 0.5-2% risk of _, a dangerous drop in white blood cells.

agranulocytosis

Besides agranulocytosis, what is another serious neurological side effect of clozapine?

Seizures.

Clozapine is unique among antipsychotics for its ability to reduce the risk of what?

Suicide.

Which two SGAs may cause QT prolongation on an electrocardiogram?

Clozapine and ziprasidone.

What is the unique mechanism of action of aripiprazole and brexpiprazole?

They are partial agonists at D2 and 5HT1A receptors.

What is a problematic adverse effect of aripiprazole, brexpiprazole, and cariprazine?

Akathisia (severe restlessness).

What is the mechanism of action of Cariprazine (Vraylar)?

It is a partial agonist at D2, D3, and 5HT1A receptors.

What are the two most common adverse drug reactions for Lumateperone (Caplyta)?

Sleepiness and dry mouth.

What is Neuroleptic Malignant Syndrome (NMS)?

A rare and potentially lethal reaction to an antipsychotic drug.

What are two of the cardinal symptoms of Neuroleptic Malignant Syndrome (NMS)?

Hyperthermia and extreme muscle rigidity are two cardinal symptoms.

Which two laboratory values are typically elevated in Neuroleptic Malignant Syndrome (NMS)?

Creatine phosphokinase (CPK) and white blood cell (WBC) count.

What is the medication Lybalvi a combination of?

Olanzapine and samidorphan.

What is the purpose of including samidorphan in the combination drug Lybalvi?

Samidorphan is a mu-opioid receptor antagonist intended to curb olanzapine-related weight gain.

What is the clinical use of Igalmi (dexmedetomidine)?

It is used for acute agitation associated with schizophrenia or bipolar disorder.

What is the mechanism of action of Igalmi (dexmedetomidine)?

It is a selective, centrally acting alpha2-adrenergic receptor agonist.

What two drugs make up the third-generation antipsychotic Cobenfy?

Xanomeline and trospium chloride.

Which adverse effect, presenting as a severe muscle spasm often in the neck, requires medication reassessment?

Torticollis.

A high fever in a patient on an antipsychotic could be a sign of which two serious conditions?

Agranulocytosis or Neuroleptic Malignant Syndrome (NMS).

Antipsychotic use during pregnancy is associated with a doubled risk of what outcome?

Pre-term birth.