4. Drugs for psychosis

What are psychoses

Very serious mental health disorders characterized by a loss of contact with reality

• Medications were not available until 1950s, people were institutionalized

Psychosis can be

Acute or chronic

Acute psychosis causes

medication overdoses

alcoholism
drug addiction

Chronic psychosis causes

BI, Bipolar disorder

Alzheimer’s disease
major depression

Which of the following disorders are associated with psychosis?

Major Depression

Schizophrenia

Traumatic brain injury

Schizophrenia

Type of psychosis characterized by: abnormal thoughts, abnormal thought processes, disordered communication, and self-isolation from others. (most common psychosis)

Onset is young adulthood

HIGH RISK OF SUICIDE

Symptoms of schizophrenia

hallucinations, delusions, paranoia, deterioration of hygiene and job/academic performance, marked withdrawal from relationships

Where do we think Schizophrenia comes from

• Linked to genes passed down

• Too much dopamine in the basal nuclei/corpus striatum and frontal cortex.

Mesolimbic Pathway

Too much dopamine

Mesocortical Pathway

Not a lot of dopamine

Nigrostriatal Pathway

Involved in the control of movement and coordination, often affected in schizophrenia leading to motor side effects of antipsychotic medications.

Tuberoinfundibular Pathway

Involved in the regulation of prolactin release and may influence hormonal balance

Which of the following is a negative symptom of schizophrenia?

• Lack of social interaction

• Severe withdrawal from relationships/social situations

• Lack of attention to
  grooming/hygiene

Which of the following is a positive symptom of schizophrenia?

Hallucinations
Hearing voices

Treatment of Schizophrenia

Antipsychotic medications 3 classes:

• Phenothiazine medications

• Nonphenothiazine medications

• Atypical antipsychotics, including clozapine.

Phenothiazine medications

Blocks dopamine receptors in the brain

• chlorpromazine

• Fluphenazine

• perphenazine

• prochlorperazine

• thioridazine

Phenothiazine class adverse events

acute dystonia, suicidality, neuroleptic malignant syndrome/NMS, Tardive dyskinesia/TD (face/tongue movements), agranulocytosis

Nonphenothiazine medications

Block dopamine receptors

• Haloperidol

• thiothixene

Nonphenothiazine class adverse events 

suicide, agranulocytosis/pancytopenia,TD, NMS, hypothermia, severe ileus

What are Phenothiazine and non-phenothiazine medications considered

• typical, or 1st generation, antipsychotic medications

• These drugs selectively antagonize dopamine D2 receptors

Atypical antipsychotic medications

2nd generation antipsychotic medications

• aripiprazole (Abilify [IM])

• olanzapine (Zyprexa [IM])

• quetiapine (Seroquel)

• risperidone (Risperdal [IM])

• clozapine (Clozaril)

Adverse Effects of Atypical(2nd Generation)

• Side effects : SIGNIFICANT WEIGHT GAIN anticholinergic effects, HA, sedation, anxiety, dizziness, EPS

• Serious adverse events: agranulocytosis, orthostatic hypotension, NMS

• Black Box warning: increased risk of death when used in elderly dementia patients

Which medications are dopamine serotonin system stabilizers 

Abilify, Rexulti, and Vraylar

What are extrapyramidal symptoms?

dystonia, akathisia, parkinsonian symptoms, bradykinesia, tremor, TD

Which of the following symptoms represents a dystonic reaction?

An isolated severe muscle spasm

Which of the following symptoms represents a parkinson’s side effect 

Shuffling gate and "Pill-rolling" tremor

Which of the following symptoms represents aTardive dyskinesia effect 

Constant lip smacking