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</p> Signup and view all the answers

    Which pharmacological agent is indicated for treatment-resistant schizophrenia?

    <p>Clozapine</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</p> Signup and view all the answers

    Which cardiovascular effect is associated with Haloperidol?

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

    What is one of the gastrointestinal side effects of Haloperidol?

    <p>Constipation</p> Signup and view all the answers

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

    <p>Lithium</p> Signup and view all the answers

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

    <p>Inositol depletion theory</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.</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.</p> Signup and view all the answers

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

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

    In what way does lithium affect GABA receptors?

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

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

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

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

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

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

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

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

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

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

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

    How do alterations in gamma oscillations affect functional brain networks?

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

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

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

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

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

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

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

    What consideration is most important when choosing treatment for schizophrenia?

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

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

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

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

    <p>Quetiapine</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</p> Signup and view all the answers

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

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

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

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

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

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

    Which medication is recommended for clozapine augmentation?

    <p>Lamotrigine</p> Signup and view all the answers

    What are benzodiazepines primarily used for in the context provided?

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

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

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

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

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

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

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

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

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

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

    <p>Clozapine</p> Signup and view all the answers

    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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