chap 11

• Antipsychotics


  Drugs that work by altering the levels of chemicals in the brain called neurotransmitters to reduce psychotic symptoms like hallucinations, delusions, and disordered thinking
• Psychosis


  • Disruptions to a person's thoughts and perceptions that make it difficult for them to recognize what is real and what isn't
  • Often experienced as seeing, hearing, and believing things that aren't real or having strange persistent thoughts, behaviors, and emotions
• Psychosis is frightening and confusing for most people
• The earliest stage of psychosis can last for weeks to years
• Combining antipsychotic medication with other therapy and support can help people manage symptoms and improve quality of life
• Family therapy, peer support, school and job counseling, and housing and employment supports can all be helpful for people experiencing psychosis
• Some therapists now offer cognitive behavioral therapy to help people cope with voices and other auditory hallucinations
• Psychosis


  A symptom, not a disease itself
• Psychosis


  A loss of contact with reality
• Symptoms of psychosis


  • Delusions
  • Hallucinations
• Psychosis can be caused by genetics, trauma, substance use, physical illness or injury, and mental health conditions
• Extreme stress or trauma can also cause psychosis
• Neurotransmitters


  Chemicals in the brain involved in psychosis, like dopamine, serotonin, and glutamate
• Psychosis


  Detachment from reality, loss of contact with reality
• The dopamine hypothesis suggests that increased dopamine is involved in psychosis, but it's not the sole cause
• Forms of psychosis


  • Hallucination
  • Delusion
• Two broad forms of psychosis

  • Hallucinations
  • Delusions
• Hallucination


  Involves the senses, feeling something that is not real
• Psychotic disorders


  • Schizophrenia
  • Manic phase of bipolar disorder
  • Acute idiopathic psychotic illness
• Delusion


  Belief in something false that is not shared by others
• Schizophrenia


  • Alteration in perception and thinking
  • Impaired social functioning
• Schizophrenia


  Most common form of psychosis, involves clear sensory experiences but marked thinking disturbance
• Symptoms of schizophrenia


  • Positive symptoms (e.g. delusions, hallucinations)
  • Negative symptoms (e.g. loss of motivation, cognitive impairment, social withdrawal)
• Symptoms of schizophrenia


  • Positive symptoms (hallucinations, delusions)
  • Negative symptoms (loss of motivation, social withdrawal)
• Antipsychotic medications can treat positive symptoms of psychosis, but not negative symptoms
• Neurotransmitter abnormalities in psychosis

  • Increased dopamine
  • Increased serotonin
  • Glutamate receptor (NMDA) dysfunction
• Typical antipsychotics


  Also called neuroleptics or first-generation antipsychotics, block dopamine receptors leading to increased risk of extrapyramidal symptoms
• Schizophrenia is a hereditary disorder, with genetic and environmental factors contributing
• Atypical antipsychotics


  Newer drugs with lower risk of extrapyramidal symptoms, block serotonin and dopamine receptors
• Stages of schizophrenia


  • Prodromal stage
  • Acute stage
  • Recovery stage
• Atypical antipsychotics are more expensive and have metabolic side effects like weight gain, hyperlipidemia, and diabetes
• Clozapine


  Highly effective antipsychotic but can cause severe agranulocytosis, should not be stopped abruptly
• Lack of a good environment and social support can contribute to relapse of psychotic episodes
• Olanzapine


  Potent antagonist of dopamine and serotonin receptors, can cause weight gain and metabolic effects
• Risk factors for psychosis

  • Genetics
  • Adverse environment/poverty
  • Birth complications
  • Winter birth
• Ziprasidone


  Can cause arrhythmia
• Typical antipsychotics (neuroleptics)


  First generation antipsychotic drugs that primarily target dopamine receptors
• Aripiprazole


  Unique mechanism as both dopamine agonist and antagonist, less weight gain
• Atypical antipsychotics


  Second generation antipsychotic drugs that target multiple neurotransmitter systems
• Antipsychotics are also used to treat depression and mania, not just psychosis