Near 346: Psychopharmacology - Schizophrenia Part III

antipsychotics or neuroleptics

What are drugs used to treat schizophrenia called?

form of slowness of motor movements

What is neurolepsis?

neurolepsis

Neuroleptics produce what?

- phenothiazines

- butyrophenones

What are the classical treatments used for schizophrenia?

- risperidonme

- aripiprazole

What are second generation(atypical) treatments to schizophrenia

- 1/3d of parents response well to treatment

- 1/3rd show improvement but relapse

- 1/3rd fail to respond to treatment

Explain the law of thirds?

DA D2 receptor antagonists

What is the main action of antipsychotics to the dopamine system?

- basal ganglia

- NAcc

- amygdala

- hippocampus

Where are D2 receptors located?

increase in DA neuron firing initially

- after is gradual decrease(auto receptors up regulate)

what happens initially when autorceptors of D2 are blocked?

CYP450 enzymes

During metabolism Antipsychotics are in competition with antidepressants and anxiolytics for what enzyme?

positive symptoms of psychosis

what kind of symptoms of schizophrenia is excessive mesolimbic D2 receptor stimulation associated with?

neuroleptic induced deficit syndrome

What syndrome is DA D2 receptor antagonists associated with?

cause:

- apathy

- anhedonia

- worsen (-) symptoms

What does the blocking of D2 receptors do?

mesocortical activity

Which DA pathway is reduced in scz?

extrapyramidal symptoms

What does EPS stand for?

involuntary changes in motor ability from antipsychotic drug treatments

What are EPS'?

restlessness and inability to remain still

What is akathisia?

involuntary muscle contractions

What is dystonia?

chronic involuntary movement disorder(affect mouth and tongue)

What is Tardive dyskinesia?

drug induced parkinsonism

What does acute blocking D2 receptors in the nigrostriatal pathway do?

tardive dyskinesia

______ increase w/ duration of treatment

VMAT2 inhibitors

What treatment is there for tardive dyskinesia?

regulates pituitary hormone secretion

What does the tuberoinfundibulnar dopamine system do?

excessive prolactin secretion

- inhibit of growth hormone

What does blocking of D2 receptors of the tuberoinfundibulnar pathway do?(block D2 receptors in pituitary gland)

decreased sex drive

- no menstruation

- breast tissue growth

What are the side effects of excessive prolactin secretion?

life threatening

- altered consciousness and ANS instability

What is the neuroleptic malignant syndrome(NMS)?

- dopamine D2

- 5HT2A

What systems do atypical antipsychotics antagonize?

found on glutamate neurons in cerebral cortex

Where are excitatory 5-HT2A receptors found?

- reduce EPS of nigrostriatal pathway

- reduce (-) symptoms

- reduce prolactin release

How does 5-HT2A modulate Da release to reduce side effects of antipsychotics?

- selective D2 receptor antagonists

- DA partial receptor agonists

- broad spectrum antipsychotics

How are atypical antipsychotics distinct?

- high affinity for D2

- slight affinity for D3

How do selective D2 receptor antagonist work?

stabilizes dopamine system

DA partial receptor agonists do what for the dopamine system?

increase(agonist) DA in PFC

- reduces(antagonist) in mesolimbic pathway

How doe partial DA agonists work, for example aripiprazole?

xxx

Need slides 21 and 22 of szc III