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At least 1 + symptom and 1 other symptoms
Over 6 months
No evidence of Drug induced or mood disorders
4 positive symptoms
Disorganized speech/formal thought disorder
3 therapeutic indications for antipsychotic agents
How long would it take to have full efficacy?
Acute episode responds faster or slower?
Slowly tapering the dose would increase or decrease relap?
Avoid what kind of SE?
What do D2 like receptor subtype antagonism do to + symptoms?
Decrease + symptoms via decreasing NAC DA signaling
What do D2 like receptor subtype antagonism do to - symptoms?
Worsen - symptoms due to decrease PFC signaling
3 SE D2 like antagonism causes?
Parkinson like symptoms initially
TD with prolong treatment
Gynecomastia: increase prolactin
5 SE caused by antimuscarinic activities
Blurred vision, Dry mouth, Contipations
Relieves initial parkinsonism
5 drugs with mid potency
Parkinson like caused by? what med could help to decrease this SE
caused by D2 blockade
L-dopa decreases SE but also decreases therapeutic effects
What's dystonia? caused by?
Involuntary muscle contractions that cause bizarre and uncontrolled movements of face, neck and tongue
What's Tardive dyskinesia/ related by?
Movements are continuous during walking
Related to increased dose and increased duration of treatment
4 pathogenesis of TD
D2 receptor hypersensitivity
D2 subtype theory
ABnormal D2/D1 ratio
D2 receptor hypersensitivity theory
Continuous exposure to DA antagonists causes increased receptor number or increased sensitivity to DA
3 treatment options for TD
discontinue antipsychotic treatment
Switch to atypical antipsychotic
What's the drawback of drug holidays
Decrease dose until symptoms decrease may return more severe even at lower dose
Characteristics of atypical antipsychotics
less potent for extrapyramidal and prolactin SE
More efficacy, less sedation, cognitive impairment, catalepsy, less TD with prolonged use
2 proposed mechanisms of atypical antipsychotics
Subregional selectivity of receptor subtype population
Dose response separation between therapeutic and motor effects
8 agent non specific SE
Weight gain, impaired glucose tolerance, hyperlipidemia, Stroke, Seizure, HTN, increased mortality in elderly with dementia, EPS, malignant syndrome
2 SE of risperidone and paliperidone
Increased risk of stroke
Worst EPS and gynecomastia of atypical class
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