Learning Objectives
• 1. Describe the dopamine hypothesis of schizophrenia
• 2. List the major receptors blocked by anti-psychotic drugs.
• 3. Describe the pharmacodynamics of older anti-psychotic
drugs and relate these characteristics to their clinical use.
• 4. Identify the main characteristics and clinical uses of newer
atypical anti-psychotic drugs.
• 5. List the major adverse effects of the anti-psychotic drugs.
Introduction to Psychiatric
Disorders
Neurosis Psychosis
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
American Psychiatric Press; 1994 ISBN: 0890420629
Neuropathology
• Genetic
Neurodevelopmental hypothesis
Neurodegenerative hypothesis
• Dopamine hypothesis
• Glutamatergic hypothesis
Ventricular enlargement in monozygotic
twin with schizophrenia
Barondes, 1993
Rapid loss of brain volume during
adolescence in Schizophrenics
• Reduce pleasure.
• Typical neuroleptics
• block the dopamine-2 receptor.
TYPICAL NEUROLEPTICS
• Typical neuroleptics:
• Respiratory depression
• DO NOT DEVELOP
• DYSTONIA
• NEUROLEPTIC MALIGNANT SYNDROME
• PARKINSONISM
• TARDIVE DYSKINESIA
• AKATHISIA
TONIC D2 Antagonism
Endocrinal adverse effects
• Weight gain
• Leucopenia , Agranulocytosis
• RARE w/ phenothiazines
• Retinal pigmentopathy
• RARE w/ phenothiazines
Atypical antipsychotics
• Unique affinity for specific receptors
• Both positive and negative symptoms
• Refractory to classical drugs
• LESS Extra pyramidal symptoms
Clozapine
• Similar to Clozapine
• MORE POTENT D2 BLOCKER.
• Extra Pyramidal Symptoms + Increased Prolactin
• CAUTION: for Increased risk of STROKE in ELDERLY.
Aripiprazole
• Atypical Antipsychotic
• PARTIAL AGONIST = D2 + 5HT1A receptors.
• EFFICACIOUS
psychosocial stressors
• Supportive therapy
• This is well SUPPORTED as an ADJUNCT to medication.
• IM Haloperidol
• Very rarely