Treatment Strategies (Part 1): Pharmacological Treatments

Examination of antipsychotic medications, their mechanisms of action across dopamine pathways, side effects, and treatment adherence strategies.

What are the two main groups that antipsychotic drugs are divided into based on their clinical characteristics?

1st generation and 2nd generation.

What is the primary mechanism of action for First Generation (Typical) Antipsychotic Drugs?

They act as full antagonists that block Dopamine Type 2 ($D2$) receptors.

How do Second Generation Antipsychotics (SGA) differ from 1st generation drugs in their interaction with neurotransmitter receptors?

SGAs act as partial agonists (stabilizers) of $D2$ and $5HT-2A$ (primary) as well as histaminergic, adrenergic, and muscarinic receptors (secondary).

In which dopamine pathway does receptor blockade lead to a reduction in positive symptoms like hallucinations and delusions?

The Mesolimbic pathway.

According to the lecture, what is the effect of dopamine blockade in the Mesocortical pathway?

An increase in negative symptoms and cognitive problems.

What is the clinical definition of Extrapyramidal Symptoms (EPS)?

Involuntary or uncontrollable movements, tremors, and/or muscle contractions, sometimes referred to as drug-induced movement disorders.

What are the primary symptoms of Neuroleptic Malignant Syndrome (NMS), a rare side effect of 1st Generation medications?

Hyperthermia, muscular rigidity, tachycardia, hyper or hypotension, autonomic instability, and Rhabdomyolysis.

What life-threatening blood disorder occurs in $1-2\%$ of people treated with Clozapine?

Agranulocytosis, which is characterized by a drop in white blood cells.

What is cited as the primary cause of relapse for most individuals with a schizophrenia-spectrum disorder?

Non-adherence to the medication regimen.

What are the specific benefits of Long-Acting Injectable (LAI) or depot antipsychotics?

They provide stable concentrations of the drug over time, prevent rapid discontinuation, lead to less hospitalization, and allow efficacy assessment without adherence issues.