What are positive symptoms of schizophrenia?
- added onto a persons personalities
1. Disturbances of reality and perception
2. Bizarre behavior
3. Hallucinations and delusions
4. May be abnormal motor symptoms - Echopraxia- unconsciously mimics action
- Posturing - put person in posture and they maintain it (Waxy flexibility)
What are negative symptoms of schizophrenia?
- things that are not present
1. Diminished speech
2. Flattened emotions
3. Apathy
4. Attention problems
5. Impaired problem solving
6. Difficulty with abstract reasoning
7. Social withdrawal
What causes schizophrenia?
- there is a genetic factor
- broad effects in the brain, but pharmacology is aimed at dopamine antagonist
Dopaminergic pathway: Hormone regulation – prolactin
Tuberoinfundibular system
Dopaminergic pathway: Motor, involved in PD
Nigrostriatal system
Dopaminergic pathway: Regulation of behavior – particularly reward, Implicated in Schizophrenia
Mesolimbic/ mesocortical system
Drug: Block D2 receptor; Effect – D2 receptor in mesolimbic/ mesocortical; Side effects – D2 receptor in nigrostriatal
- Positive symptoms – reduce
- Negative symptoms – less effective; May enhance – apathy, reduce initiative
typical antipsychotic drug
What are the typical neuroleptic drugs?
- Chlorpromazine
- Triflupromazine
- Thioridazine
- Haloperidol (Haldol)
- Loxapine
- Flupenthixol
- may have non-compliance
What is an ADR of typical antipsychotics?
- “dirty” drug
- Most are antagonists at D-receptors, Muscarinic receptors, alpha-adrenergic receptors, and histaminergic receptors
What are the anticholinergic actions?
- Dry mouth
- Blurry vision
- Constipation
- Urinary retention
- Tachycardia
- Prolonged QRS interval
- Confusion
- Exacerbation of glaucoma
What are the anti-alpha-1 adrenergic actions?
- Orthostatic hypotension – mostly first couple of days
- Prolonged QT interval
- Reflex tachycardia
- Dizziness
- Incontinence
- Sedation
What are the anti-histamine actions?
- Sedation
2. Weight gain
What are the anti-dopaminergic actions?
- Extrapyramidal side effects (EPS) - motor problems seen in PD
- Akathisia (restless legs) – early onset
- Pseudoparkinsonism - early
- Acute dystonias – early – more often in young, male patients
- Tardive Dyskinesia – late onset, may not resolve itself once off the drug
Involuntary and fragmented movements; More of a problem with older drugs; May take a long time to resolve or may be irreversible
Tardive dyskinesia
- much higher risk in typical antipsychotics
Seen after high doses of more potent drugs; Symptoms: Catatonia, Stupor, Rigidity, Tremors, Fever; can lead to death
Neuroleptic malignant syndrome
What are some other uses of anti-psychotic drugs?
- Nausea and vomiting
- Hiccups
- Huntington’s disease
- Tourette’s syndrome
- Combined with narcotics to treat chronic pain
Why would you move to an atypical antipsychotic drugs?
- less risk of Extra pyramidal side effects
- less side effects over all
- less likely to withdraw
- first choice for maintenance therapy
What are some typical neuroleptic ADRs other than the side effects relating to peripheral receptor blocking?
- Dermatological - Hypersensitivity rashes, Photosensitivity reactions
- Hematological - Leukopenia
- Endocrinological - Hyperprolactinemia (Amenorrhea, galactorrhea, infertility, osteoporosis, gynecomastia)
What are the atypical neuroleptic drugs?
- Clozapine
- Olanzapine
- Quetiapine
- Aripiprazole
- Risperidone
What are the ADRs for atypical neuroleptic drugs?
- Weight gain
- Hyperglycemia
- Dyslipidemia
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