1. conventional antipsychotic drugM1 1
conventional antipsychotic drug D2
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Stahl S M, Essential Psychopharmacology (2000)

2. pure D2 blocker
11-2
Stahl S M, Essential Psychopharmacology (2000)

3. Increase in negative symptoms
Mesocortical pathway
11-3
Stahl S M, Essential Psychopharmacology (2000)

4. Nigrostriatal pathway
EPSs
Nigrostriatal pathway
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Stahl S M, Essential Psychopharmacology (2000)

5. This up-regulation may lead to tardive dyskinesia
Blockade of receptors in the nigrostriatal dopamine pathway causes them to up-regulate
This up-regulation may lead to tardive dyskinesia
11-5
Stahl S M, Essential Psychopharmacology (2000)

6. Motor and mental features of neuroleptic-induced extrapyramidal side effects
Parkinsonism Tremor (resting), rigidity, bradykinesia, masklike facies
Akathisia Restlessness, pacing, fidgeting, shifting from jitteriness, anxiety, irritability, anger, difficulty concentrating
Dystonia Muscle contractions, tongue protrusion, torticollis, opisthotonos, fear, distress, paranoia
Tardive Buccolingual-masticatory movements of irregular
dyskinesia (nonrhythmic) nature; choreiform or athetoid (writhing) movements of fingers, extremities, trunk
Adapted from Ayd 1995; Casey 1995

7. pituitary lactotroph D2 antagonist D2 receptor prolactin
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Stahl S M, Essential Psychopharmacology (2000)

8. Typical antipsychotic drugs: potencies and side effect profiles
Drug Approximate Sedative Hypotensive Anticholinergic Extrapyramidal
dose (mg) effect effect effect effect
Phenothiazines
Chlorpromazine (Thorazine) H H M L
Piperidines
Thioridazine (Mellaril) H H H L
Piperazines
Fluphenazine (Prolixin) M L L H
Perphenazine (Trilafon) L L L H
Trifluoperazine (Stelazine) M L L H
Thioxanthene
Thiothixene (Navane) L L L H
Butyrophenones
Haloperidol (Haldol) L L L H

9. 5HT2A
SDA D2
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Stahl S M, Essential Psychopharmacology (2000)

10. 5HT-DA Interactions brake Substantia nigra brake raphe nucleus
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Stahl S M, Essential Psychopharmacology (2000)

11. dopamine neuron serotonin neuron dopamine Substantia nigra
5HT2A receptor
serotonin
5HT2A receptor
serotonin neuron
Raphe
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Stahl S M, Essential Psychopharmacology (2000)

12. mesocortical pathway SDA serotonin primary dopamine deficiency
dopamine release
SDA
serotonin
secondary dopamine deficiency
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Stahl S M, Essential Psychopharmacology (2000)

13. Nigrostriatal pathway
5HT2A receptor
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Stahl S M, Essential Psychopharmacology (2000)

14. clozapine 5HT1A 5HT2A 5HT2C 5HT3 5HT6 D2 5HT7 H1 M1 1 2 D1 D3 D4
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Stahl S M, Essential Psychopharmacology (2000)

15. 5HT2A 1
risperidone 2 D2
5HT7
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Stahl S M, Essential Psychopharmacology (2000)

16. olanzapine 5HT2A 5HT2C 5HT3 5HT6 D2 H1 M1 1 D1 D3 D4
11-40
Stahl S M, Essential Psychopharmacology (2000)

17. H1
5HT2A 1
quetiapine 2 D2
5HT6
5HT7
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Stahl S M, Essential Psychopharmacology (2000)

18. ziprasidone 5HT1A 5HT2A 5HT1D 5HT2C D2 5HT7 1 SRI NRI D3
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Stahl S M, Essential Psychopharmacology (2000)

19. Side effects of selected atypical agents

20. POSITIVE SYMPTOM PHARMACY
polypharmacy
combos
3rd line treatment
clozapine D2
2nd line treatment D2
noncompliant (depot)
SDA
1st line treatment D2 BZ
in case of emergency
POSITIVE SYMPTOM PHARMACY
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Stahl S M, Essential Psychopharmacology (2000)

21. Hierarchy of Treatment Goals in Medical Psychotherapy of Schizophrenia
Acute Phase
Medical/neuropsychiatric assessment
Rapid symptom reduction
Reduce impact of episode on friends, family, housing, activities
Convalescent Phase
Gain trust/alliance with family/caregivers
Assess and mobilize social supports
Ensure human service needs are met (food, clothing, housing)
Ensure safety and predictability of environment
Adaptive Plateau
Establish therapeutic alliance/supportive treatment routine
Achieve effective maintenance medication regime
Stable plateau
Psychoeducation: Promote illness self-management strategies, awareness of relationship between stress and symptoms
Rehabilitation: Teach adaptive competencies