Week 6
Answer the questions pertaining to Psychopharmacology. A minimum of one paragraph per question. ADDRESS ALL PARTS OF THE QUESTIONS. Questions must be answered in detail and provide references if any are used.
1. Describe the original set of antipsychotic medications.
2. Describe the difference (pharmacologically–DA receptors…) between the original antipsychotic medications and the atypical antipsychotic medication.
3. Argue for one valid reason a schizophrenic patient would rather ask for Haldol over Clozapine (hint: side effects discussion). Be descriptive! Hint: look to one particularly dangerous side effect.
4. Describe a new antipsychotic on the market: Caplyta (Lumaterperone). What is it, how does it work in the brain (what does it affect in the brain), and what is it used for?
5. REAL-WORLD ISSUE: Describe any newer medications for psychotic disorders that are different from the typical and atypical antipsychotics (release date 2017 or newer).
Answers:
- The original set of antipsychotic medications, also known as typical or first-generation antipsychotics, were primarily dopamine antagonists. They worked by blocking dopamine receptors in the brain, specifically the D2 receptor subtype. The original antipsychotic medications include chlorpromazine (Thorazine), haloperidol (Haldol), and fluphenazine (Prolixin). These medications were effective in treating the positive symptoms of schizophrenia, such as hallucinations and delusions, but were associated with many side effects, including extrapyramidal symptoms (EPS), such as dystonia, akathisia, and tardive dyskinesia.
- The main difference between the original antipsychotic medications and atypical antipsychotic medications is their mechanism of action. Atypical antipsychotic medications, also known as second-generation antipsychotics, target both dopamine and serotonin receptors in the brain. They have a higher affinity for serotonin receptors than dopamine receptors, and some have little to no affinity for D2 receptors. Atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), and clozapine (Clozaril). Atypical antipsychotics are associated with fewer EPS than the original antipsychotic medications and are effective in treating both the positive and negative symptoms of schizophrenia.
- One valid reason a schizophrenic patient might prefer Haldol over Clozapine is that Clozapine is associated with a potentially life-threatening side effect called agranulocytosis. Agranulocytosis is a condition where the body does not produce enough white blood cells, which can leave a patient susceptible to infections. Patients taking Clozapine are required to have regular blood tests to monitor their white blood cell count. If their white blood cell count drops too low, they may have to discontinue the medication. This can be a significant burden for patients who have to go to the doctor frequently for blood tests. In contrast, while Haldol is associated with EPS, these symptoms can be treated with additional medication, and patients may prefer to deal with these side effects rather than risk the potentially life-threatening side effects associated with Clozapine.
- Caplyta (Lumateperone) is a new antipsychotic medication that was approved by the U.S. Food and Drug Administration (FDA) in 2019. It is a novel antipsychotic medication that works by modulating serotonin, dopamine, and glutamate neurotransmission in the brain. Specifically, it acts as a serotonin 5-HT2A receptor antagonist and a postsynaptic dopamine D2 receptor partial agonist. Caplyta is used to treat adults with schizophrenia and works by reducing the positive symptoms of schizophrenia, such as hallucinations and delusions. Caplyta is associated with a lower risk of EPS than some older antipsychotic medications, and it has a relatively low risk of weight gain.
-
As of my knowledge cutoff of 2021, there were no new medications for psychotic disorders that were significantly different from typical and atypical antipsychotics that were approved and released for clinical use in 2017 or later.
However, there have been some recent developments in the field of medication for psychotic disorders that may offer new treatment options in the future. One such development is the use of long-acting injectable formulations of atypical antipsychotics. These formulations allow for sustained release of the medication over several weeks, providing a more convenient and potentially more effective treatment option for patients who have difficulty adhering to daily oral medications.
Another potential future option is the use of glutamate-based medications. Glutamate is an important neurotransmitter involved in learning and memory, and it has been implicated in the pathophysiology of schizophrenia. While there are no glutamate-based medications currently approved for the treatment of psychotic disorders, there is ongoing research exploring this avenue of treatment.
It is important to note that medication for psychotic disorders should always be prescribed and monitored by a qualified healthcare professional, and patients should never modify their medication regimen without consulting their healthcare provider.
