001-ANTIPSYCHOTICS-LectureA-2011.key

001-ANTIPSYCHOTICS-LectureA-2011.key - Antipsychotic...

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Psychopharmacology Spring 2011 Harvey Alan Berman, PhD Hberman@buffalo.edu Antipsychotic agents
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Objectives • Describe the dopamine hypothesis of schizophrenia • List the major receptors blocked by antipsychotic drugs • Understand the pharmacology of the – Older “typical” antipsychotic agents – Newer “atypical” antipsychotic agents • Understand the adverse effects of antipsychotic agents
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Questions What is schizophrenia? What does this all mean? What are their adverse effects? What are the mechanisms of action? What drugs are used to treat schizophrenia? What are its causes?
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Reading Goodman and Gilman’s Manual (2008) – Chapter 18: pp 299-314 – Chapter 18: pp 461-481 (big book) Golan, Chapter 12 (pp. 195-200) T. R. Insel (2010) “Rethinking schizophrenia” Nature, 468, 187-193. D. Dobbs (2010) “The making of a troubled mind” Nature, 468, 154-156. R. Freedman (2005)”The choice of antipsychotic drugs for schizophrenia” NEJM, 353, 1286-1288.
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What is Schizophrenia? • The schizophrenic disorders are psychotic conditions that manifest massive disruptions of perception, cognition, emotion and behaviors • Not a unitary disorder • Has varied clinical presentations, natural histories, family histories and treatment responses
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Symptoms of psychosis Positive – Hallucinations – Delusions – Disorganized speech and behavior – Combativeness – Agitation – Paranoia Negative – Emotional withdrawal – Blunted affect – Avolition – Anhedonia – Alogia – Poor self-care Cognitive – Memory – Attention – Executive function
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Positive Symptoms: Function is Distorted Hallucinations – Abnormalities with perception Delusions – Abnormalities in inferential thinking Disorganized speech – Abnormalities in thought language Bizarre behavior – Behavioral monitoring/motor behavior
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Negative Symptoms: Function is Diminished Alogia – Loss of fluency of speech / thought Affective blunting – Loss in capacity to express emotions fluently Avolition – Loss of volition and drive Anhedonia / asociality – Problems with pleasure and emotional attachment Attention impairment – Focusing attention
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Hallucination • A sensory misinterpretation which occurs without any external stimulus – Classified in terms of sensory spheres involved. – Visual and auditory hallucinations are the most common
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Delusion • A thought, idea, or belief with three characteristics – It is not true – It can’t be reasoned with – It is not shared by the individual’s cultural/ religious group. I.e., it is out of harmony with the individual’s educational or cultural background / surroundings.
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Schizophrenia-Diagnosis Criterion A : two or more of the following for at least 1 month 1. delusions 2. hallucinations 3. disorganized speech 4. grossly disorganized or catatonic behavior 5. negative symptoms Only 1 Criterion A symptom is required if: 1. delusions are bizarre
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This note was uploaded on 03/06/2011 for the course PMY 406 taught by Professor Berman during the Spring '11 term at SUNY Buffalo.

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001-ANTIPSYCHOTICS-LectureA-2011.key - Antipsychotic...

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