NURS660 Exam
Positive Symptoms of Schizophrenia - ANSWER Delusions, hallucinations,
distortions, agitation, disorganized speech, disorganized behavior
Where do positive symptoms originate? - ANSWER Mesolimbic dopamine pathway
Medications to treat positive symptoms - ANSWER Antipsychotics
Negative symptoms of schizophrenia - ANSWER Flat affect, alogia, affective
blunting, asociality, anhedonia, avolition.
Where do negative symptoms originate? - ANSWER Mesocortical dopamine
pathway. May also involve mesolimbic regions such as nucleus accumbens
Medications to treat negative symptoms - ANSWER Vraylar, amisulpride
Hypotheses of Schizophrenia - ANSWER -Mesolimbic pathway is hypothesized to be
hyperactive resulting in excess dopamine at the synapse.
-The gluatamate activity at NMDA receptors is hypofunctional
Mesolimbic Pathway Theory of Schizophrenia - ANSWER Mesolimbic pathway is
hyperactive, resulting in excess dopamine at the synapse which leads to positive
symptoms. Hyperactivity of mesolimbic dopamine neurons may also play a role in
aggression and hostile symptoms.
Five Different Dopamine Pathways in the brain - ANSWER -Nigrostriatal Dopamine
Pathway
-Mesolimbic dopamine pathway
-Mesocorticol dopamine pathway
-Tuberoinfundibular dopamine pathway
-Thalamic dopamine pathway
Nigrostriatal pathway - ANSWER Projects from the substantia nigra to the basal
ganglia or striatum.
-Part of the extrapyramidal nervous system
-Controls motor function and movement
-When dopamine is deficient, can cause parkinsonism with tremor, rigidity, and
akinesia/bradykinesia
-Excess dopamine- can cause hyperkinetic movements, such as tics and
dyskinesias
Mesolimbic dopamine pathway - ANSWER Projects from the midbrain ventral
tegmental area to the nucleus accumbens (part of limbic system) where many
behaviors such as pleasurable sensations, the powerful euphoria of drug abuse as
well as delusions and hallucinations.
, Mesocortical pathway - ANSWER Projects from the ventral tegmental area to the
prefrontal cortex and is important for cognition
Tuberofundibular pathway - ANSWER Projects from the hypothalamus to the
anterior pituitary gland and controls prolaction secretion
Thalamic pathway - ANSWER Arises from multiple sites.
-Function not well known, may be involved in sleep and arousal mechanisms
Major neurotransmitters involved in schizophrenia - ANSWER -Dopamine
-Glutamate
Dopamine and Schizophrenia - ANSWER Major neurotransmitter in schizophrenia
Some atypical psychotics block dopamine receptors
Increased in schizophrenia
Glutamate and schizophrenia - ANSWER Considered the "master switch" of the
brain. Glutamate is the major excitatory neurotransmitter of the CNS as it can turn on
nearly all of the CNS neurons
Decreased in schizophrenia
Neuroleptic Malignant Syndrome - ANSWER -Adverse reaction to antipsychotics
with severe "lead pipe" rigidity, FEVER, and mental status changes
-Lab findings- increased CK, leukocytosis, low serum iron
-Caused by dopamine antagonists
-Slower in onset, 1-2 weeks after starting/changing therapy.
-Manage by stopping causative agent, supportive care, ECT, Dantrolene,
bromocriptine, and amantadine.
Serotonin Syndrome - ANSWER -Caused by serotonergic agents
-Hyperreflexia, myoclonus, ocular clonus
-Manage by stopping all serotonergic agents, supportive care aimed at normalization
of vitals, sedation with benzos, administration of serotonergic antagonists, and
antidote therapy with cyproheptadine
-Assess need to resume use of causative serotonergic meds after resolution of
symptoms
-Symptoms seen within 24 hours of starting/changing therapy.
The "-pine" family - ANSWER Have 5-HT2A and D2 antagonism.
Strong potency for H1 and muscarinic receptors
Clozapine, Olanzapine, Quetiapine,
Clozapine - ANSWER Atypical Antipsychotic
SE: AGRANULOCYTOSIS- ANC blood testing prior, during. Can be very sedating,
excessive salivation, Increased risk of myocarditis, Greatest degree of weight gain
and possibly greatest cardiometabolic risk
Indications- treatment resistant schizophrenia, reducing suicidal behavior
Drug interactions with Clozapine - ANSWER Potential to increase levels: SSRIS,
cipro, cimetidine, macrolides, caffeine
Positive Symptoms of Schizophrenia - ANSWER Delusions, hallucinations,
distortions, agitation, disorganized speech, disorganized behavior
Where do positive symptoms originate? - ANSWER Mesolimbic dopamine pathway
Medications to treat positive symptoms - ANSWER Antipsychotics
Negative symptoms of schizophrenia - ANSWER Flat affect, alogia, affective
blunting, asociality, anhedonia, avolition.
Where do negative symptoms originate? - ANSWER Mesocortical dopamine
pathway. May also involve mesolimbic regions such as nucleus accumbens
Medications to treat negative symptoms - ANSWER Vraylar, amisulpride
Hypotheses of Schizophrenia - ANSWER -Mesolimbic pathway is hypothesized to be
hyperactive resulting in excess dopamine at the synapse.
-The gluatamate activity at NMDA receptors is hypofunctional
Mesolimbic Pathway Theory of Schizophrenia - ANSWER Mesolimbic pathway is
hyperactive, resulting in excess dopamine at the synapse which leads to positive
symptoms. Hyperactivity of mesolimbic dopamine neurons may also play a role in
aggression and hostile symptoms.
Five Different Dopamine Pathways in the brain - ANSWER -Nigrostriatal Dopamine
Pathway
-Mesolimbic dopamine pathway
-Mesocorticol dopamine pathway
-Tuberoinfundibular dopamine pathway
-Thalamic dopamine pathway
Nigrostriatal pathway - ANSWER Projects from the substantia nigra to the basal
ganglia or striatum.
-Part of the extrapyramidal nervous system
-Controls motor function and movement
-When dopamine is deficient, can cause parkinsonism with tremor, rigidity, and
akinesia/bradykinesia
-Excess dopamine- can cause hyperkinetic movements, such as tics and
dyskinesias
Mesolimbic dopamine pathway - ANSWER Projects from the midbrain ventral
tegmental area to the nucleus accumbens (part of limbic system) where many
behaviors such as pleasurable sensations, the powerful euphoria of drug abuse as
well as delusions and hallucinations.
, Mesocortical pathway - ANSWER Projects from the ventral tegmental area to the
prefrontal cortex and is important for cognition
Tuberofundibular pathway - ANSWER Projects from the hypothalamus to the
anterior pituitary gland and controls prolaction secretion
Thalamic pathway - ANSWER Arises from multiple sites.
-Function not well known, may be involved in sleep and arousal mechanisms
Major neurotransmitters involved in schizophrenia - ANSWER -Dopamine
-Glutamate
Dopamine and Schizophrenia - ANSWER Major neurotransmitter in schizophrenia
Some atypical psychotics block dopamine receptors
Increased in schizophrenia
Glutamate and schizophrenia - ANSWER Considered the "master switch" of the
brain. Glutamate is the major excitatory neurotransmitter of the CNS as it can turn on
nearly all of the CNS neurons
Decreased in schizophrenia
Neuroleptic Malignant Syndrome - ANSWER -Adverse reaction to antipsychotics
with severe "lead pipe" rigidity, FEVER, and mental status changes
-Lab findings- increased CK, leukocytosis, low serum iron
-Caused by dopamine antagonists
-Slower in onset, 1-2 weeks after starting/changing therapy.
-Manage by stopping causative agent, supportive care, ECT, Dantrolene,
bromocriptine, and amantadine.
Serotonin Syndrome - ANSWER -Caused by serotonergic agents
-Hyperreflexia, myoclonus, ocular clonus
-Manage by stopping all serotonergic agents, supportive care aimed at normalization
of vitals, sedation with benzos, administration of serotonergic antagonists, and
antidote therapy with cyproheptadine
-Assess need to resume use of causative serotonergic meds after resolution of
symptoms
-Symptoms seen within 24 hours of starting/changing therapy.
The "-pine" family - ANSWER Have 5-HT2A and D2 antagonism.
Strong potency for H1 and muscarinic receptors
Clozapine, Olanzapine, Quetiapine,
Clozapine - ANSWER Atypical Antipsychotic
SE: AGRANULOCYTOSIS- ANC blood testing prior, during. Can be very sedating,
excessive salivation, Increased risk of myocarditis, Greatest degree of weight gain
and possibly greatest cardiometabolic risk
Indications- treatment resistant schizophrenia, reducing suicidal behavior
Drug interactions with Clozapine - ANSWER Potential to increase levels: SSRIS,
cipro, cimetidine, macrolides, caffeine
