60 Questions
Which of the following is a symptom of schizophrenia according to the DSM-5?
Hallucinations
How are psychoses classified in terms of their causes?
Functional vs medical
What is the 'organic' basis of psychiatric disorders increasingly being understood as?
A disorder of the biochemistry of the brain
What is the meaning of 'psychotic' in the context of schizophrenia?
Being out-of-touch with reality
What are delusions in the context of schizophrenia?
Fixed false beliefs
What type of perceptions are typically experienced in hallucinations related to schizophrenia?
Sensory perceptions in the absence of a physical stimulus
Which adverse effect is specifically associated with antipsychotics that have histamine H1 receptor antagonism?
Metabolic syndrome
Which adverse effect is most closely linked to the use of antipsychotics in elderly patients with dementia-related psychosis?
Sudden cardiac death
Which type of bipolar disorder is characterized by episodes of major depression and hypomania?
Type-2
Which medication is known for effectively reducing the risk of suicide in bipolar disorder despite having a narrow therapeutic index?
Lithium
What effect does increased dietary sodium have on the efficacy and toxicity of lithium?
Decreases efficacy and toxicity
Which condition shares similar symptoms with neuroleptic malignant syndrome?
Serotonin syndrome
What is a key characteristic of schizophrenia according to the DSM-5?
Having noticeable deterioration in social or occupational functioning for at least 6 months
What is a known limitation of antipsychotics in treating schizophrenia?
Being less effective for relieving negative and cognitive symptoms
When were antipsychotic drugs discovered?
In the 1930s by Rhône-Poulenc Co. during efforts to develop antihistamines
What is the term 'neuroleptic' referring to in relation to antipsychotic drugs?
Their ability to slow motor activity and decrease emotionality
What is a potential adverse effect of antipsychotics in addition to blocking dopamine receptors?
Postural hypotension
What role does estrogen play in schizophrenia?
It may have a 'protective' role, delaying the onset of the disorder in women
Which type of antipsychotics have higher affinity for 5HT2A receptors compared to D2 receptors?
Second generation antipsychotics (SGA)
Which movement disorder occurs later in therapy and is the most problematic?
Tardive dyskinesia
Which drug was FDA approved in 2017 for the treatment of tardive dyskinesia?
Valbenazine
Which type of antipsychotics are marketed as more effective and safer than first generation antipsychotics (FGA)?
SGA
Which neurotransmitter receptor's affinity varies by individual drug among SGA?
Other neurotransmitter receptors
Which drug is a D2 receptor partial agonist among SGA?
Aripiprazole
Which type of antipsychotic drugs have rapid calming effects within hours to a few days?
2nd generation antipsychotics
Which antipsychotic drug was removed from the market in 1975 due to causing agranulocytosis in ~1% of patients?
Clozapine
Which hospital held a peak population of 16,000 patients, making it the largest psychiatric hospital in the world?
Pilgrim State Hospital
Which category of antipsychotic drugs is further classified as 'low potency' or 'high potency' based on dopamine receptor blockade?
1st generation antipsychotics
Which antipsychotic drugs are categorized based on receptor affinity, sedation, extrapyramidal symptoms, hyperprolactinemia, and partial agonist effects?
2nd generation antipsychotics
Which antipsychotic drugs were developed as clozapine-like agents, with eight additional SGAs approved since then?
Risperidone, Olanzapine, and Quetiapine
What is the meaning of 'psychotic' in the context of schizophrenia?
Being out-of-touch with reality
In the DSM-5, which of the following symptoms is present in schizophrenia?
All of the above
How are psychoses classified in terms of their causes?
As functional or medical
What is the 'organic' basis of psychiatric disorders increasingly being understood as?
A disorder of the biochemistry of the brain
What type of perceptions are typically experienced in hallucinations related to schizophrenia?
Sensory perceptions in the absence of a physical stimulus
What is a potential adverse effect of antipsychotics in addition to blocking dopamine receptors?
Hyperprolactinemia
Which movement disorder associated with antipsychotic drugs occurs early in therapy and is characterized by a subjective feeling of inner restlessness and the urge to move?
Akathisia
Which neurotransmitter receptors do second generation antipsychotics (SGA) have higher affinity for compared to D2 receptors?
5HT2A
Which antipsychotic drug, FDA approved in 2017, is specifically used for the treatment of tardive dyskinesia?
Valbenazine
Which category of antipsychotic drugs is further classified as 'low potency' or 'high potency' based on dopamine receptor blockade?
First generation antipsychotics (FGA)
Which adverse effects of antipsychotics are movement disorders known as Extra-Pyramidal Symptoms (EPS)?
Pseudo-parkinsonism
Which drug companies' prioritization of profits over humanitarian needs is attributed to the combination of the Orphan Drug Act of 1983 and what type of healthcare system?
Profit-based healthcare system
Which adverse effect is NOT commonly associated with antipsychotics?
Hypertension
Which type of bipolar disorder is characterized by episodes of major depression and hypomania?
Type-2
Which antipsychotic is specifically mentioned for its higher risk of lowering the seizure threshold?
Clozapine
What is a known adverse effect of therapeutic concentrations of lithium?
Renal dysfunction
Which adverse effect is specifically associated with the use of lithium during pregnancy?
Neural tube defects
What effect does increased dietary sodium have on the efficacy and toxicity of lithium?
Decreases efficacy and toxicity
Which neurotransmitter receptor subtype do antipsychotics primarily block to reduce positive symptoms of schizophrenia?
Dopamine D2 receptor
What is the key exclusion criteria for diagnosing schizophrenia according to the DSM-5?
Substance abuse
What is the age range for the typical onset of initial symptoms of schizophrenia in males?
15-24 years
Which drug was the first to be approved by the FDA for the treatment of schizophrenia?
Chlorpromazine
Which neurotransmitter pathway is believed to be involved in the cause of schizophrenia?
Dopaminergic pathway
What type of symptoms are antipsychotics less effective for relieving in schizophrenia?
Negative symptoms
Which antipsychotic drug was reintroduced in 1989 with strict guidelines and found use in managing treatment-resistant patients with fewer movement and neuroendocrine side effects?
Clozapine
Which antipsychotic drug was approved in 1972 but removed from the market in 1975 due to causing agranulocytosis in ~1% of patients?
Clozapine
Which hospital initially designed for 12,500 patients on 1,900 acres held a peak population of 16,000 patients, making it the largest psychiatric hospital in the world?
Pilgrim State Hospital in New York
Which of the following is a characteristic of '1st generation' (FGA) antipsychotics?
Low potency based on dopamine receptor blockade
Which statement about the incidence of schizophrenia is correct?
The incidence of schizophrenia is approximately 1%
Which of the following is a specific property used to categorize '2nd generation' (SGA) antipsychotics?
Receptor affinity, sedation, extrapyramidal symptoms, hyperprolactinemia, and partial agonist effects
Study Notes
Antipsychotic Drugs: Key Points
- Before antipsychotic drugs, treatments for schizophrenia included crude and horrifying methods like trepanation, exorcism, and extermination.
- The incidence of schizophrenia is approximately 1%, and many states had hospitals exclusively for its treatment, such as Pilgrim State Hospital in New York.
- Pilgrim State Hospital, initially designed for 12,500 patients on 1,900 acres, held a peak population of 16,000 patients, making it the largest psychiatric hospital in the world.
- Antipsychotics have rapid calming effects within hours to a few days, with marked differences in potency and effective doses.
- Antipsychotic drugs are categorized into two major groups: "1st generation" (FGA) and "2nd generation" (SGA) antipsychotics.
- "1st generation" antipsychotics are further classified as "low potency" or "high potency," based on dopamine receptor blockade.
- The first "2nd generation" antipsychotic, clozapine, was approved in 1972 but removed from the market in 1975 due to causing agranulocytosis in ~1% of patients.
- Clozapine was reintroduced in 1989 with strict guidelines and found use in managing treatment-resistant patients with fewer movement and neuroendocrine side effects.
- Risperidone (1995), olanzapine (1996), and quetiapine (1997) were developed as clozapine-like agents, with eight additional SGAs approved since then.
- FDA-approved antipsychotic drugs include "azines" and "dols," and some have been withdrawn due to cardiac arrhythmias.
- Specific properties of SGAs are categorized based on receptor affinity, sedation, extrapyramidal symptoms, hyperprolactinemia, and partial agonist effects.
- Antipsychotic drugs have varied effects on dopaminergic pathways in the brain, impacting movement disorders, arousal, sensory processing, behavior control, and prolactin secretion.
Antipsychotic Drugs: Key Points
- Before antipsychotic drugs, treatments for schizophrenia included crude and horrifying methods like trepanation, exorcism, and extermination.
- The incidence of schizophrenia is approximately 1%, and many states had hospitals exclusively for its treatment, such as Pilgrim State Hospital in New York.
- Pilgrim State Hospital, initially designed for 12,500 patients on 1,900 acres, held a peak population of 16,000 patients, making it the largest psychiatric hospital in the world.
- Antipsychotics have rapid calming effects within hours to a few days, with marked differences in potency and effective doses.
- Antipsychotic drugs are categorized into two major groups: "1st generation" (FGA) and "2nd generation" (SGA) antipsychotics.
- "1st generation" antipsychotics are further classified as "low potency" or "high potency," based on dopamine receptor blockade.
- The first "2nd generation" antipsychotic, clozapine, was approved in 1972 but removed from the market in 1975 due to causing agranulocytosis in ~1% of patients.
- Clozapine was reintroduced in 1989 with strict guidelines and found use in managing treatment-resistant patients with fewer movement and neuroendocrine side effects.
- Risperidone (1995), olanzapine (1996), and quetiapine (1997) were developed as clozapine-like agents, with eight additional SGAs approved since then.
- FDA-approved antipsychotic drugs include "azines" and "dols," and some have been withdrawn due to cardiac arrhythmias.
- Specific properties of SGAs are categorized based on receptor affinity, sedation, extrapyramidal symptoms, hyperprolactinemia, and partial agonist effects.
- Antipsychotic drugs have varied effects on dopaminergic pathways in the brain, impacting movement disorders, arousal, sensory processing, behavior control, and prolactin secretion.
Test your knowledge of antipsychotic drugs with this quiz covering key points such as the history of treatments for schizophrenia, the categories and properties of antipsychotics, and the impact of these drugs on dopaminergic pathways in the brain.
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