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Questions and Answers
What is the main characteristic of neurosis?
What is the main characteristic of neurosis?
- Anxiety (correct)
- Personality derangement
- Hallucinations
- Delusions
Which term best describes a mental disorder marked by derangement of personality, loss of contact with reality, delusions, hallucinations, and illusions?
Which term best describes a mental disorder marked by derangement of personality, loss of contact with reality, delusions, hallucinations, and illusions?
- Affective disorders
- Neurosis
- Organic psychoses
- Psychosis (correct)
What are neuroleptic drugs also known as?
What are neuroleptic drugs also known as?
- Antidepressants
- Antipsychotic drugs (correct)
- Hypnotics
- Anxiolytics
Which of the following is NOT a type of psychosis mentioned in the text?
Which of the following is NOT a type of psychosis mentioned in the text?
What distinguishes neurosis from psychosis?
What distinguishes neurosis from psychosis?
Which term describes mental disturbances caused by head injury, alcoholism, or drugs?
Which term describes mental disturbances caused by head injury, alcoholism, or drugs?
What do structural changes in the brain, such as atrophy of the temporal lobe, correlate with?
What do structural changes in the brain, such as atrophy of the temporal lobe, correlate with?
Which neurotransmitter, besides dopamine, is mentioned to potentially be involved due to its complex interaction in schizophrenia?
Which neurotransmitter, besides dopamine, is mentioned to potentially be involved due to its complex interaction in schizophrenia?
Which drugs that release dopamine in the brain can induce positive symptoms of schizophrenia?
Which drugs that release dopamine in the brain can induce positive symptoms of schizophrenia?
What do potent dopamine agonists like apomorphine and bromocriptine do in relation to schizophrenia symptoms?
What do potent dopamine agonists like apomorphine and bromocriptine do in relation to schizophrenia symptoms?
Which receptor density is found to be increased in schizophrenic brains?
Which receptor density is found to be increased in schizophrenic brains?
Besides action on dopamine receptors, what else do several neuroleptics block?
Besides action on dopamine receptors, what else do several neuroleptics block?
Which of the following is a common therapeutic effect of neuroleptic drugs?
Which of the following is a common therapeutic effect of neuroleptic drugs?
What is a key reason why neuroleptic drugs are not effective in treating motion sickness?
What is a key reason why neuroleptic drugs are not effective in treating motion sickness?
Which adverse effect on the motor system is associated with a deficit in dopamine due to neuroleptic drug use?
Which adverse effect on the motor system is associated with a deficit in dopamine due to neuroleptic drug use?
What can help manage the extrapyramidal motor effects caused by neuroleptic drugs?
What can help manage the extrapyramidal motor effects caused by neuroleptic drugs?
Which symptom is characteristic of tardive dyskinesia induced by long-term use of neuroleptic drugs?
Which symptom is characteristic of tardive dyskinesia induced by long-term use of neuroleptic drugs?
How do neuroleptic drugs affect the emotions and arousal levels of patients?
How do neuroleptic drugs affect the emotions and arousal levels of patients?
What is Pimavanserin primarily used for?
What is Pimavanserin primarily used for?
In which condition is the use of neuroleptics like Clozapine cautioned in the elderly, especially those with dementia?
In which condition is the use of neuroleptics like Clozapine cautioned in the elderly, especially those with dementia?
What is a potential benefit of using neuroleptics like Clozapine in some cases?
What is a potential benefit of using neuroleptics like Clozapine in some cases?
When was Pimavanserin FDA approved for managing Parkinson's disease psychosis?
When was Pimavanserin FDA approved for managing Parkinson's disease psychosis?
What is the mechanism of action of Pimavanserin at 5-HT2A receptors?
What is the mechanism of action of Pimavanserin at 5-HT2A receptors?
Which condition is NOT listed as an appropriate clinical use of neuroleptics?
Which condition is NOT listed as an appropriate clinical use of neuroleptics?
Which side effect of neuroleptic drugs is related to blurred vision and dry mouth?
Which side effect of neuroleptic drugs is related to blurred vision and dry mouth?
What is a common symptom of the Extrapyramidal System (EPS) side effect of neuroleptic drugs?
What is a common symptom of the Extrapyramidal System (EPS) side effect of neuroleptic drugs?
Which effect is associated with the Antihistaminic effect (H1) of neuroleptic drugs?
Which effect is associated with the Antihistaminic effect (H1) of neuroleptic drugs?
Long term use of neuroleptics is effective in preventing the recurrence of which condition?
Long term use of neuroleptics is effective in preventing the recurrence of which condition?
Which condition is associated with the Endocrine side effects of neuroleptic drugs?
Which condition is associated with the Endocrine side effects of neuroleptic drugs?
What is a common cardiovascular side effect of neuroleptic drugs?
What is a common cardiovascular side effect of neuroleptic drugs?
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Study Notes
Neuroleptic Drugs
- Neuroleptic drugs are also known as anti-schizophrenic drugs, antipsychotic drugs, or major tranquilizers.
- They are used to treat disorders such as schizophrenia, mania, behavioral emergencies, and drug-induced emesis.
- They can be used in the elderly with or without dementia, but with caution.
Schizophrenia
- Schizophrenia is a mental disorder characterized by derangement of personality and loss of contact with reality.
- It can be accompanied by delusions, hallucinations, and illusions.
- There are three important types of psychosis: schizophrenia, affective disorders (mania and depression), and organic psychoses.
Mechanism of Action
- Neuroleptic drugs produce a state of apathy and reduced initiative, suppressing emotions and aggressive tendencies.
- They block dopamine receptors in the brain, which can lead to extrapyramidal effects.
Adverse/Side Effects
- Extrapyramidal effects include:
- Parkinson-like symptoms (reversible and dose-related)
- Tardive dyskinesia (more serious and slow to develop)
- Other side effects include:
- Anticholinergic effects (blurred vision, dry mouth, urinary retention)
- Cardiovascular effects (postural hypotension, QT prolongation)
- Autonomic effects (dry mouth, blurred vision, constipation)
- Sedation (diminishes with continued use)
- Weight gain (related to metabolic effects)
- Endocrine effects (gynecomastia, lactation, and painful breasts)
- Idiosyncratic and hypersensitivity reactions (jaundice, leucopenia, agranulocytosis, skin rash, and neuroleptic malignant syndrome)
Therapeutic Considerations
- Neuroleptic drugs are effective in controlling the symptoms of acute schizophrenia.
- Long-term use is effective in preventing recurrence.
- Depot preparations are often used for maintenance.
- Neuroleptics are not effective in improving "negative" schizophrenic symptoms.
- About 40% of patients are poorly controlled by neuroleptic drugs ("neuroleptic resistant").
Dopamine Hypothesis
- Evidence supports the dopamine hypothesis, which suggests that changes in the dopamine system contribute to the development of schizophrenia.
- Examples include:
- Amphetamines can induce positive symptoms of schizophrenia.
- Potent dopamine agonists can exacerbate schizophrenia symptoms.
- Dopamine antagonists and drugs that deplete dopamine are effective in controlling positive symptoms.
- Increased dopamine receptor density in schizophrenic brains.
- However, there are also shortcomings to the dopamine hypothesis, such as:
- Normal or low levels of homovanillic acid (HVA) in CSF and postmortem brains.
- No change in activity of dopamine metabolizing enzymes.
- Normal prolactin levels.
5-HT Hypothesis
- The 5-HT system may also be involved in the development of schizophrenia.
- Examples include:
- Lysergic acid diethylamide (LSD), a central 5-HT partial agonist, produces hallucinations and sensory disturbances.
- Some neuroleptics also block 5-HT2 receptors.
Other Neuroleptics
- Pimavanserin is an inverse agonist and antagonist at 5-HT2A receptors, used to treat Parkinson's disease psychosis and as an adjunct to other antipsychotics in schizophrenia management.
- Clozapine may be effective in resistant cases, but with caution due to increased death rate.
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