Psychotic Disorders and Schizophrenia Quiz
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Questions and Answers

What is the mechanism of action for Clozapine?

  • Direct stimulation of GABA receptors
  • Selective agonist of dopamine Type 2 receptors
  • Inhibition of serotonin release at 5HT1 receptors
  • Selective monoaminergic antagonist with high affinity for multiple receptors (correct)

Which of the following is NOT a central nervous system adverse effect of Haloperidol?

  • Akathisia
  • Extrapyramidal reactions
  • Hyperglycemia (correct)
  • Drowsiness

Which adverse effect is commonly associated with Clozapine?

  • Abdominal pain
  • Ocular disturbances
  • Transient tachycardia
  • Leukopenia (correct)

What receptor does Clozapine primarily antagonize to exhibit anticholinergic effects?

<p>Muscarinic M1-5 receptors (B)</p> Signup and view all the answers

Which pharmacological agent is indicated for treatment-resistant schizophrenia?

<p>Clozapine (B)</p> Signup and view all the answers

What type of skin reactions may occur as a side effect of Haloperidol?

<p>Maculopapular and acne-like (C)</p> Signup and view all the answers

Which cardiovascular effect is associated with Haloperidol?

<p>QT-prolongation (A)</p> Signup and view all the answers

What is one of the gastrointestinal side effects of Haloperidol?

<p>Constipation (A)</p> Signup and view all the answers

What is considered the first-line therapy for bipolar disease?

<p>Lithium (A)</p> Signup and view all the answers

Which theory explains lithium's potential action on targets within the cell?

<p>Inositol depletion theory (B)</p> Signup and view all the answers

What is the primary function of lithium with respect to inositol monophosphatase?

<p>It acts as an uncompetitive inhibitor. (B)</p> Signup and view all the answers

Which of the following statements about lithium's therapeutic range is true?

<p>It requires careful monitoring due to its narrow therapeutic range. (C)</p> Signup and view all the answers

Which downstream effect is NOT associated with lithium's mechanism of action?

<p>Decrease in GABA concentration (A)</p> Signup and view all the answers

In what way does lithium affect GABA receptors?

<p>It enhances GABA receptor activity. (C)</p> Signup and view all the answers

Which enzyme's regulation by GSK-3 is influenced by lithium?

<p>Other enzymes involved in gene expression (A)</p> Signup and view all the answers

What effect does lithium have on the Myoinositol pathway?

<p>It inhibits enzyme activity in an inversely proportional manner. (B)</p> Signup and view all the answers

What is the primary method of elimination for lithium from the body?

<p>Through urine (A)</p> Signup and view all the answers

Which of the following is NOT a common acute adverse effect of lithium therapy?

<p>Deep vein thrombosis (B)</p> Signup and view all the answers

What must be monitored regularly if lithium treatment continues during pregnancy?

<p>Serum lithium concentrations (B)</p> Signup and view all the answers

At what serum lithium level does acute toxicity begin to occur?

<p>1.2 mM (C)</p> Signup and view all the answers

What is the recommended action regarding lithium dosage before delivery?

<p>Decrease or stop 2-3 days before delivery (D)</p> Signup and view all the answers

Which adverse effect is associated with lithium treatment in male reproductive health?

<p>Reduced sperm motility (D)</p> Signup and view all the answers

What is a significant risk of continuing lithium treatment while breastfeeding?

<p>Thyroid dysfunction in infants (D)</p> Signup and view all the answers

What is the expected time frame for the delayed effects of lithium in clinical symptom improvement for bipolar depression?

<p>6-8 weeks (B)</p> Signup and view all the answers

What is the effect of the loss of pyramidal cell dendritic spines?

<p>Net reduction in excitatory activity (C)</p> Signup and view all the answers

What is the relationship between excitatory input and GABAergic interneurons?

<p>Reduced excitatory input leads to less GABAergic activity (B)</p> Signup and view all the answers

How do alterations in gamma oscillations affect functional brain networks?

<p>They lead to aberrant gamma activity (B)</p> Signup and view all the answers

What role do psychosocial stressors play in the response to triggers in schizophrenia?

<p>They sensitize the subcortical dopamine system (C)</p> Signup and view all the answers

Which of the following mechanisms is proposed to underlie cognitive and negative symptoms in schizophrenia?

<p>Impairment in the interplay of excitatory and inhibitory neurons (D)</p> Signup and view all the answers

What impact do cortical deficits have on regulatory control in schizophrenia?

<p>They impair regulatory control (B)</p> Signup and view all the answers

What is the consequence of reduced interneuron inhibition of pyramidal cells?

<p>Increased pyramidal excitatory output (D)</p> Signup and view all the answers

What is a proposed effect of aberrant gamma activity on the brain?

<p>Contribution to cognitive deficits (A)</p> Signup and view all the answers

What is the first line of therapy recommended for the treatment of positive symptoms in schizophrenia?

<p>Olanzapine &amp; Risperidone (C)</p> Signup and view all the answers

What consideration is most important when choosing treatment for schizophrenia?

<p>Adverse effects (C)</p> Signup and view all the answers

When evaluating treatment resistance in schizophrenia, what factor must be excluded first?

<p>Comorbid substance misuse (D)</p> Signup and view all the answers

What is specifically excluded from use in initial treatment of schizophrenia?

<p>Quetiapine (D)</p> Signup and view all the answers

What is the required trial period for clozapine before it can be recommended?

<p>Up to 1 year (B)</p> Signup and view all the answers

What is the primary consideration in the maintenance treatment phase for schizophrenia?

<p>Adherence to treatment (A)</p> Signup and view all the answers

What type of antipsychotics are generally considered equally effective for treating positive symptoms?

<p>Both SGA and FGA (D)</p> Signup and view all the answers

What is stated about Haloperidol in regard to its results in treatment?

<p>Not good results (C)</p> Signup and view all the answers

What is the recommended duration for the initial trial of treatment?

<p>4 weeks (B)</p> Signup and view all the answers

Which medication is recommended for clozapine augmentation?

<p>Lamotrigine (A)</p> Signup and view all the answers

What are benzodiazepines primarily used for in the context provided?

<p>Alleviate distress (D)</p> Signup and view all the answers

What is a noted risk associated with the recommended combination of treatments?

<p>Increased risk of relapses (B)</p> Signup and view all the answers

In some cases, what is recommended to reduce adverse effects?

<p>Use of adjunct medications (D)</p> Signup and view all the answers

Which patient group is mentioned in the context regarding treatment recommendations?

<p>Patients with treatment-resistant schizophrenia (D)</p> Signup and view all the answers

Which is NOT explicitly mentioned as part of the treatment strategy?

<p>Therapeutic lifestyle changes (C)</p> Signup and view all the answers

Which of the following medications poses a high risk of adverse effects?

<p>Clozapine (C)</p> Signup and view all the answers

Flashcards

GABAergic inhibition

Inhibition of neurons by gamma-aminobutyric acid (GABA).

Pyramidal cell dendritic spines

Small protrusions on pyramidal neurons where synapses form.

Loss of dendritic spines

Reduced number of connection points on pyramidal neurons.

Reduced excitatory input

Lower stimulation received by GABAergic interneurons.

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Gamma oscillations

Brain wave patterns crucial for neural activity.

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Stress and dopamine system

Stress can worsen a person's sensitivity to dopamine.

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Subcortical dopamine system

Dopamine-producing areas below the cerebral cortex.

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Cortical deficits

Deficiencies in brain regions that lead to regulatory issues.

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Lithium's role in Bipolar Disorder

Lithium is a first-line treatment for Bipolar Disorder, recommended by major psychiatric associations.

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Lithium's therapeutic success

Lithium is the most effective drug among antidepressants and mood stabilizers in suicide prevention.

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Lithium's mechanism (unknown)

The exact way lithium works in the body is still not fully understood.

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Lithium's narrow therapeutic range

Lithium's effectiveness is within a specific range, requiring careful monitoring to avoid side effects.

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Inositol depletion theory

A theory proposing that lithium affects inositol's role in metabolic pathways within the brain.

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Inositol Monophosphatase inhibition

Lithium acts as an inhibitor of inositol monophosphatase, a key enzyme in inositol metabolism.

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Lithium's effect on GSK-3

Lithium regulates GSK-3, an enzyme affecting other metabolic processes (likely via phosphorylation).

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Lithium and GABA

Lithium may enhance the effects of GABA, a neurotransmitter, which potentially impacts brain activity.

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Haloperidol's antiemetic activity

Haloperidol reduces nausea and vomiting by acting on dopamine D2 receptors in the chemoreceptor trigger zone (CTZ).

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Haloperidol adverse effects

Haloperidol can cause central nervous system (e.g., extrapyramidal symptoms), gastrointestinal (e.g., constipation), neuromuscular, and dermatologic side effects.

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Clozapine classification

Clozapine is an atypical antipsychotic, chemically derived from dibenzodiazepines.

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Clozapine mechanism of action

Clozapine's mechanism involves antagonism of diverse receptors like serotonin (5HT2), dopamine (D2), and various adrenergic receptors.

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Clozapine indication

Clozapine is used to treat treatment-resistant schizophrenia.

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Clozapine's receptor types

Clozapine selectively blocks receptors like serotonin 5HT2, dopamine D2, adrenergic (alpha 1 and 2), and histamine H1 receptors, as well as muscarinic M1-5.

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Liver effects of Haloperidol

Haloperidol use can potentially impair liver function or cause jaundice.

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Dermatologic reactions to Haloperidol

Haloperidol can cause skin reactions like maculopapular rash, acne-like conditions, photosensitivity, or hair loss.

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Lithium Toxicity Levels

Blood lithium levels above 1.2 mM are considered toxic, causing nausea, diarrhea, and tremors; levels above 2-3.5 mM can be fatal.

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Lithium Elimination

Lithium is primarily eliminated through the kidneys; elimination via the feces is negligible.

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Lithium Therapy Delay

Symptom improvement from lithium therapy can take 6-8 weeks for bipolar depression.

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Lithium Adverse Effects (Acute)

Common short-term side effects include gastrointestinal issues like nausea, vomiting, loss of appetite, and diarrhea.

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Lithium Adverse Effects (General)

Lithium treatment can lead to various adverse effects across several organ systems, including cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurological, sexual, and teratogenic impacts.

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Lithium and Male Reproductive Health

Lithium can negatively impact male reproductive organs, including sperm production (spermatogenesis) and testosterone levels.

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Lithium in Pregnancy

Lithium use during pregnancy requires careful consideration of the risks and benefits; blood levels must be monitored and reduced/stopped pre-delivery to avoid harm to the mother and/or newborn.

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Lithium and Breastfeeding

Breastfeeding is generally not recommended while a mother is taking lithium; if continued, the infant should be monitored for thyroid function.

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First-Episode Schizophrenia Treatment

Initial treatment for individuals experiencing schizophrenia for the first time. All antipsychotics are considered equally effective for positive symptoms.

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Treatment Duration

The recommended duration of treatment for first-episode schizophrenia is 1-2 years.

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Typical Antipsychotics (FGA)

Older generation antipsychotics, less commonly used in first-episode schizophrenia due to side effects. Haloperidol is an example.

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Atypical Antipsychotics (SGA)

Newer generation antipsychotics, preferred for first-episode schizophrenia. Examples include Olanzapine, Risperidone, and Amisulpride.

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Treatment Resistance in Schizophrenia

When a patient doesn't respond adequately to treatment despite proper adherence and excluding factors like substance misuse.

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Clozapine as Treatment of Choice

Clozapine is generally recommended as the first-line treatment for treatment-resistant schizophrenia.

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Trial of Olanzapine, Risperidone, or Amisulpride

Before considering clozapine for treatment resistance, a trial with olanzapine, risperidone, or amisulpride is recommended.

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Treatment Trial Duration

The duration of a treatment trial for clozapine can be up to one year.

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Antipsychotic augmentation

Combining an antipsychotic with another drug to enhance its effectiveness, often used for treatment-resistant schizophrenia.

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Clozapine

A type of antipsychotic medication known for its effectiveness in treating schizophrenia, especially when other treatments fail.

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Benzodiazepines

A class of drugs that primarily act on the brain, reducing anxiety and calming a person down.

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Treatment-resistant schizophrenia

Schizophrenia that does not respond well to standard antipsychotic treatments, requiring alternative strategies.

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Lamotrigine

A medication often used to treat bipolar disorder but also considered for schizophrenia, particularly for the augmentation of antipsychotics.

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Adverse effects

Unwanted or harmful side effects that can occur with medication, like nausea or drowsiness.

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Initial trial period

The first stage of treatment to test the effectiveness of a medication, lasting for a specific period.

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Relapses

The return of symptoms after a period of improvement, often seen in conditions like schizophrenia.

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Study Notes

Psychotic Disorder and Schizophrenia Drug

  • Psychotic spectrum disorders group together disorders linked to the fragmentation of reality.
  • The DSM-V nosography classifies disorders such as schizophrenia, delusional disorder, paranoid disorder, schizoid disorder, schizotypic disorder, schizoaffective disorder, brief psychotic disorder, psychotic break, and catatonia.
  • These disorders are defined by abnormalities in five domains: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms.
  • Criterion A requires two (or more) of these symptoms for one month or longer.
  • Criterion B involves significant impairment in major life areas (work, interpersonal, etc.).
  • Criterion C involves continuous signs for at least 6 months, with at least one month of active-phase symptoms.
  • Criterion D excludes schizoaffective and bipolar disorders with psychotic features.
  • Criterion E rules out substance or medical conditions.
  • Criterion F involves prominent delusions or hallucinations present for at least one month if there's a history of autism spectrum disorder or communication disorder.

Objectives

  • Define the classification of antipsychotic drugs.
  • Differentiate the pharmacokinetics and pharmacodynamics of major antipsychotics.
  • Understand the pharmacokinetics, pharmacodynamics, adverse effects, and drug interactions of antipsychotics.

Clinical Concept

  • Criterion A: At least 2 of these, including one of 1-3
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized behavior
  • Negative symptoms
  • Criterion B: Significant impairment in at least one major area of functioning.
  • Criterion C: Continuous signs for at least 6 months.
  • Criterion D: Rule out schizoaffective and bipolar with psychotic features.
  • Criterion E: Substance and medical conditions ruled out
  • Criterion F: Prominent delusions or hallucinations for a month in conditions like autism or communication disorder

Stress, Dopamine, and Psychosis

  • Psychosocial stressors can sensitize the subcortical dopamine system, making it more responsive to later triggers, while cortical deficits impair regulatory control.
  • Later triggers like stress can lead to inappropriate dopamine release and aberrant assignments of stimuli.
  • First generation antipsychotics (FGAs), such as chlorpromazine, haloperidol, fluphenazine, flupentixol, and clopentixol, primarily target dopamine.
  • Second generation antipsychotics (SGAs), like clozapine, risperidone, quetiapine, amisulpride, aripiprazole, and zotepine, target both dopamine and serotonin.

Chlorpromazine

  • Prototypical phenothiazine antipsychotic.
  • Antipsychotic action thought to be due to long-term adaptation of dopamine receptors.
  • Used as an antiemetic and for intractable hiccups.
  • Antagonist for multiple receptors types, including dopamine, serotonin, histamine, and cholinergic receptors.
  • Adverse effects include weight gain, cardiovascular issues (hypotension, syncope), genitourinary problems (breast engorgement, urinary retention), drowsiness, dystonia, extrapyramidal reactions, contact dermatitis, and skin photosensitivity.

Haloperidol

  • Phenylpiperidine butyrophenone antipsychotic.
  • Primarily used to treat schizophrenia and other psychoses.
  • Used for schizoaffective disorder, delusional disorders, ballism, and Tourette syndrome.
  • Inhibits dopamine and increases its turnover by binding more tightly to dopamine D2 receptors, reducing dopamine neurotransmission.
  • Common adverse effects include central nervous system issues (extrapyramidal reactions, parkinsonism, dystonia, akathisia), gastrointestinal issues (constipation, abdominal pain), neuromuscular issues (hyperkinesia, tremor), diaphoresis, breast engorgement, cardiac effects, and liver effects.

Clozapine

  • Tricyclic dibenzodiazepine atypical antipsychotic agent.
  • Used for treatment-resistant schizophrenia.
  • Antagonist at serotonin (5HT2), dopamine (D2), alpha1, alpha2, and histamine H1 receptors.
  • Adverse effects include tachycardia, hypertension/hypotension, drowsiness, sedation, dizziness, insomnia, vertigo, sialorrhea, weight gain, constipation, nausea, vomiting, dyspepsia, fever, agranulocytosis, leukopenia, toxic delirium, and neuroleptic malignant syndrome.

Risperidone

  • Second-generation antipsychotic.
  • Primarily targets dopamine and serotonin pathways, reducing symptoms of schizophrenia and mood disorders in more effective ways.
  • High affinity for 5-HT2A receptors.
  • Adverse effects include hyperprolactinemia, weight gain, appetite increase, constipation, drowsiness, bradycardia, and sexual dysfunction.

Quetiapine

  • Used for schizophrenia and acute manic episodes.
  • Its antipsychotic effects are thought to be due to dopamine and serotonin receptor antagonism.
  • Adverse effects include increased blood pressure, drowsiness, skin rash, hyperprolactinemia, nausea, and diarrhea.

Lithium

  • Used to treat manic episodes and prevent suicide among bipolar patients.
  • Mechanism of action is complex and incompletely understood.
  • Narrow therapeutic range, requiring careful monitoring to avoid toxicity, which can result in death.
  • Adverse effects include low thyroid, heart issues, and electrolyte imbalances, among other things.
  • Not recommended during pregnancy or breastfeeding.

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Description

Test your knowledge on psychotic disorders with a focus on schizophrenia and related conditions. This quiz covers classifications, symptoms, and criteria based on the DSM-V nosography. Challenge yourself and enhance your understanding of these complex mental health disorders.

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