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Pharmacodynamics
Acute psychosis
The basics
Pharmacokinetics
All those studies...
100
First generation antipsychotics and risperdal tend to increase prolactin levels via this dopaminergic central pathway.
What is the neurohyposeal system? page 84
100
While the anterior cingulate or limbic system may underlie more classic or "positive" psychotic symptoms, this brain region may be particularly important when considering negative symptoms.
What is dorsolateral prefrontal cortex. ie mesocortical dopamine neurons enhance frontal lobe function via 5-HT effects. page 100
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Throughout the world, this if the lifetime prevalence of schizophrenia.
What is about 1%? page 70
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True or false; human brain levels of antipsychotics are approximately 10 to 20 times higher than plasma levels and they stay in the brain longer than in plasma.
What is true? page 89
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True or false; Studies suggest that patients who respond inadequately to a first generation antipsychotic should receive a trial with another second generation antipsychotic before considering clozapine.
What is true? page 101
200
Name two compounds that can potentiate dopamine and thus inducing paranoia, hallucinations and other manifestations of psychosis.
What is L-dopa, amantadine, stimulants, bromocriptine, apomorphine, lisuride? page 86
200
This agent is a highly specific dopamine antagonist with fewer adverse effects than haloperidol, open studies demonstrated efficacy for acute schizophrenia and equally effective in maintenance therapy, and is FDA labeled for Tourette's syndroms.
What is pimozide? page 97
200
This hypothesis postulates that the increased concentration of patients with schizophrenia in the lower socioeconomic stratum is the result of their impaired functioning.
What is the social drift hypothesis? page 70
200
In the McEvoy study, higher doses of haloperidol did not produce greater improvement in measures of psychosis, but they did lead to slightly more improvement in this.
What is hostility? page 93
200
In of study of clozapine for the treatment of patients who had previously been severely psychotic and unresponsive, improvement in these indiviudals appeard to be associated with a decreased risk of this.
What is suicide? page 101. Results reproduced in the international prevention of suicide (intersept) trial, randomly assigned to clozapine or zyprexa, hence FDA approved clozapine for reduction of risk of suicide.
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Geodon and abilify are partial agonists at this receptor, which may also modulate dopamine activity.
What is 5-HT1A receptor? page 87
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A stronger predominance of 5-HT2A versus D2 receptor occupancy, combined with gradual occupancy of D2 receptors differentiates this agent from the other second generation antipsychotics.
What is risperdal? page 103 Note: higher 5-HT2 affinity provides some protection against EPS, yet this effect is lost when D2 receptor occupancy exceeds a certain threshold.
300
These are the four fundamentals symptoms Swiss psychiatrist Eugen Bleuler used to describe schizophrenia.
What is autism, ambivalence, abnormal thoughts, and abnormal affect? page 69
300
This haloperidol plasma level correlates to rapid increase in striatal D2 occupancy up to 80%, which was shown by PET studies to increase the risk of EPS.
What is 5 to 15ng/mL? page 93
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According to the first phase of Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) this agent had the highest metabolic issues, this agent was the only agent associated with improvement in metabolic variable and EPS was highest with this agent.
What is olanzapine, ziprasidone, and perphenazine. page 98
400
Name the five dopaminergic tracts and highlight which one is responsible for psychotic symptoms and EPS symptoms.
What is striatal system (EPS), mesolimbic system (psychotic symptoms), mesocortical system, retinal system, neurohypophyseal system page 84
400
This second generation antipsychotic has a lower affinity for D2 receptor (D2 occupancy rate between 20% and 67%), blocks 5-HT2 receptors, and binds more to D1 and D4.
What is clozapine? page 100
400
Name at least 4 of Schineiderian first rank symptoms used to describe the hallucinations and delusions thought to be typical of schizophrenia.
What is: audible thoughts, voices arguing, voices commenting, somatic passivity, thought withdrawal, thought insertions, thought broadcasting, impulses, volitional acts or feelings that are not ones own but imposed by outside forces, delusional pereptions? page 71
400
Coryell et al. found this relationship between haloperidol plasma levels and outcome at week 1, which did not persist into weeks 2,3,4.
What is a negative linear relationship, ie as dose is increased, response is decreased. page 90
400
When risperdal was studied for conduct problems in developmentally disabled men, results yielded a decrease in self injurious behavior, but the most striking finding was the reduction of this, which was not due to sedation because social interactions also increased.
What is aggression? page 105
500
Briefly give the half lives of the second generation anitpsychotics.
What is quetiapine 3-7 hours, ziprasidone 5-10 hours, clozpaine 12 hours, risperidone 20 hours, olanzapine 20-70 hours, Aripiprazole 75 hours page 88
500
This second generation antipsychotic is the first approved antipsychotic that is not a pure D2 antagonist. Rather is is a partial agonist at D2 as well as 5-HT1A. It is also an antagonist at the 5-HT2 receptor.
What is Aripiprazole? page 111
500
True or false; current literature indicates that enlarged ventricles and reduced cortical volume or activity are negatively correlated with: positive and negative symptoms poor performance on neuropsychological tests the presence of soft neurological signs poorer response to treatment a worse prognosis
What is false? page 73
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These two substances are inhibitors of CYP450 1A2 and when combined with clozapine leads to increased plasma levels and adverse effects of dizziness and excess salivation. While these two other substances induces 1A2 and leads to decreased clozapine plasma levels.
What is coffee and luvox? What is smoking and phenytoin? page 94
500
In considering parenteral treatment of psychotic agitation, this agent offers some advantages over haloperidol in overall efficacy and rapidity of onset, however has been assoicated with OT prolongation and a greater risk of cardiac arrhythmias.
What is droperidol? page 114