Week 3 Clinical pearls

Major current hypothesis for cause of schizophrenia

Glutamate activity at NMDA receptors is hypofunctional due to abnormalities in the formation of glutamatergic NMDA synapses during neurodevelopment

Extrapyramidal Symptoms (EPS)

Manifest when dopamine receptor occupancy within the basal ganglia reaches approximately 80%, as the dopamine-mediate inhibition of movement is now disinhibited

Risperidone (Risperdal)

Medication with highest risk for galactorrhea

Clozapine (Clozaril)

Only antipsychotic documented to decrease the risk of suicide in schizophrenic clients.

One of the only antipsychotics that does not cause dystonia.

Aripiprazole (Abilify)

associated with the lowest risk of weight gain

Antipsychotic medications most associated with weight gain

“Pines”

Olanzapine (Zyprexa), Quetiapine (Seroquel), Clozapine (Clozaril), Asenapine (Saphris)

Haloperidol (Haldol)

First-generation antipsychotic that can cause a dystonic reaction

The “Pines” binding affinity

All “pines” bind much more potently to the serotonin 2A receptor than to the dopamine 2 receptor or show similar potency at both receptors

Clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), asenapine (Saphris)

Atypical antipsychotic receptor binding

Nearly all atypical (second generation) antipsychotics have an affinity for blocking serotonin 2A receptors that is equal to or greater than their affinity for blocking dopamine 2 receptors

The “Dones” binding affinity

The “dones” bind much more potently to serotonin 2A receptors than to dopamine 2 receptors, or show similar potency

Tuberoinfundibular pathway

associated with hyperprolactinemia

Mesolimbic pathway

Associated with positive symptoms of psychosis and schizophrenia

Mesocortical pathway

Associated with negative symptoms of psychosis/schizophrenia

Nigrostriatal pathway

Part of the extrapyramidal nervous system and associated with extrapyramidal symptoms (EPS)

Used when other antipsychotics fail

Clozapine (Clozaril)

Not a first-line treatment. Treatment recommendation is to use only after two other sequential antipsychotic trials fail with monotherapy.

Used for treatment-resistant cases due serious side effects.

Potential serious side effects of clozapine (Clozaril)

Agranulocytosis, myocarditis, seizures.

Due to agranulocytosis, requires frequent CBCs.

ANC monitoring for clozapine (Clozaril)

First 6 months: weekly

Second 6 months: every 2 weeks

After 1 year: monthly