Psychosis and Schizophrenia: Thinking It Through

Cover......Page 1
Psychosis and Schizophrenia: Thinking It Through......Page 2
©......Page 3
Table of Contents......Page 4
CME Information......Page 6
1. Neurobiology of Schizophrenia......Page 10
Key Dopamine Pathways......Page 11
The Dopamine Hypothesis of Schizophrenia: Positive Symptoms......Page 12
The Dopamine Hypothesis of Schizophrenia: Negative, Cognitive, and Aff ective Symptoms......Page 13
The Integrated Dopamine Hypothesis of Schizophrenia......Page 14
Key Glutamate Pathways......Page 15
NMDA Receptor Hypofunction Hypothesis of Schizophrenia......Page 16
Role of Glutamate in Schizophrenia......Page 17
Opposing Actions of 5HT1A and 5HT2A Receptors on Dopamine Release......Page 18
Regulation of Dopamine Release by Serotonin in the Nigrostriatal Pathway......Page 19
Somatodendritic Blockade of 5HT2A Receptors Leads to Increased Dopamine Release......Page 20
Serotonin Also Modulates Cortical Glutamate Release......Page 21
2. Pharmacology and Side Effects of Antipsychotics......Page 22
Conventional Antipsychotics......Page 23
Side Effects Due to Chronic D2 Blockade......Page 24
Additional Side Eff ects of Conventional Antipsychotics......Page 25
Properties of Atypical Antipsychotics......Page 26
Pharmacological Profile of Atypical Antipsychotics......Page 27
Combined 5HT2A/D2 Receptor Blockade Leads to Less EPS......Page 28
Effects of 5HT2A Blockade in the Mesocortical DA Pathway......Page 29
Prolactin Regulation by DA and 5HT in the Tuberoinfundibular Pathway......Page 30
Rapid Dissociation Theory of Atypical Antipsychotic Action......Page 31
Conventional vs. Atypical Antipsychotics......Page 32
Conventional vs. Atypical Antipsychotics......Page 33
The Agonist Spectrum: The Theory Behind Partial Agonists......Page 34
How is the Dopamine Spectrum Related to Receptor Output?......Page 35
D2 and D3 Partial Agonists: Overview......Page 36
5HT1A Partial Agonism of Atypical Antipsychotics......Page 37
Which Receptors Can Hypothetically Lead to Cardiometabolic Risk or Sedation?......Page 38
Metabolism of Antipsychotics by CYP450 Enzymes......Page 39
3. Currently Available Antipsychotics and Upcoming Antipsychotics With Novel Mechanisms of Action......Page 40
Aripiprazole......Page 41
Asenapine......Page 42
Clozapine......Page 43
Iloperidone......Page 44
Olanzapine......Page 45
Paliperidone......Page 46
Quetiapine......Page 47
Risperidone......Page 48
Ziprasidone......Page 49
Sertindole......Page 50
Cariprazine......Page 51
Lurasidone......Page 52
The Future of Antipsychotics......Page 53
Pharmaceutical Manipulation of Glutamate Neurotransmission......Page 54
4. Optimizing Functional Outcomes in Schizophrenia......Page 56
Treating Positive and Negative Symptoms of Schizophrenia......Page 57
Treating Metabolic Issues and Sedation......Page 58
Reducing Side Effects to Optimize Functional Outcome......Page 59
Dosing and Side Effect Factors That May Affect Adherence......Page 60
Cognitive Dysfunction and Functional Outcome......Page 61
Switching Strategies......Page 62
Summary......Page 66
Suggested Reading......Page 67
CME Posttest......Page 70