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Dopamine inhibits pituitary prolactin synthesis
Dopamine antagonists increase prolactin

Symptoms: amenorrhoea, galactorrhoea, low libido

*Aripiprazole reduces prolactin production*

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1. Rhythmic Movements

2. Grimace & Chewing

3. Lip smacking

Treatment = Tetrabenzine

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Let us know in the comments below if what you would first prescribe a patient newly diagnosed with schizophrenia.

How would you try to improve compliance in patients reluctant to take their antipsychotic medications?

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Very effective but very problematic

Common side-effects: constipation, hypersalivation, weight gain

Emergency side-effects: agranulocytosis, myocarditis

Requires regular monitoring

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1. Tremor

2. Rigidity

3. Bradykinesia

Treatment = Change Drug/ Pro-Cyclidine (Anti-Cholinergic)

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1. Restless

2. Pacing

3. (Un)Crossing Legs

Treatment = Change Drug/ Propranolol

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Efficacy?
Side-effects?

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1. Abnormal Tone

2. Torticollis = Twisting of the neck

3. Oculogyric Crises = Upward Deviation of eyes

Treatment = Pro-Cyclidine (Anti-Cholinergic)

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METABOLIC
Weight gain
Diabetes
Raised cholesterol

Others:
Q for Quetiapine, Q for QT interval prolongation
Risperidone causes extra-pyramidal side effects

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EXTRA-PYRAMIDAL = ADAPT
Acute Dystonia
Akathisia
Parkinsonism
Tardive dyskinesia

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A 21-year old university student has been admitted onto the psychiatric ward following a suicide attempt. He reports a 6 month history of beliefs about his flatmates being spies trying to poison him, and says that he had begun hearing voices that were encouraging him to end his life to escape them. A diagnosis of schizophrenia was reached, what would be the best pharmacological treatment to commence him on?

Explain your reasoning in the Teams chat

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AKA 2nd Generation

Examples: Olanzapine, Aripiprazole, Risperidone, Quetiapine, Clozapine
MOA: Dopamine and serotonin receptor antagonists
(and many other receptors)

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AKA 1st Generation
Examples: Haloperidol, Chlorpromazine, Zuclopenthixol Deconate (Clopixol)
MOA: Dopamine Receptor Antagonists