Question

Which of the following agents is an antipsychotic that can improve both positive and negative symptoms of schizophrenia? (A) chlorpromazine (B) haloperidol (C) thiothixene (D) risperidone (E) thioridazine

Short answer

Risperidone (D)

Step-by-step solution

Understanding Schizophrenia Symptoms

Schizophrenia includes positive symptoms, such as hallucinations and delusions, and negative symptoms, such as lack of emotion or motivation. Effective treatment should address both types of symptoms.

Antipsychotic Classification

Antipsychotics can be categorized into typical and atypical. Typical antipsychotics primarily target positive symptoms, while atypical antipsychotics can address both positive and negative symptoms.

Identifying Typical Antipsychotics

Among the given options, chlorpromazine, haloperidol, thiothixene, and thioridazine are classified as typical antipsychotics. They mainly alleviate positive symptoms of schizophrenia.

Identifying Atypical Antipsychotic

Risperidone is classified as an atypical antipsychotic. It is known to improve both the positive and negative symptoms of schizophrenia.

Final Decision

Based on the classification and characteristics, risperidone effectively improves both positive and negative symptoms of schizophrenia.

Key concepts

Positive Symptoms

Positive symptoms in schizophrenia are those where an individual experiences a distortion or an excess of normal functions. These symptoms are often more noticeable and can include hallucinations, delusions, and disorganized thinking. Essentially, these symptoms represent an addition to the person's behavior and beliefs that wouldn't normally be present.

Hallucinations may involve seeing, hearing, or sensing things that are not actually there, with auditory hallucinations being the most common. Delusions are false beliefs that are resistant to reason or confrontation with actual fact. For example, someone might believe they have exceptional abilities or that they're being persecuted.

• Hallucinations: Experiencing sensations that aren't real.
• Delusions: Holding onto false beliefs despite contrary evidence.
• Disorganized Thinking: Difficulty in forming coherent thoughts or sentences.

Addressing these symptoms requires specific medication and therapeutic approaches to help individuals discern reality more effectively and ease these distressing experiences.

Negative Symptoms

Negative symptoms of schizophrenia reflect an absence or a decrease in normal functions and behaviors. They often manifest as emotional flatness, lack of interest in life, and withdrawal from social activities. These symptoms can be particularly challenging as they are less obvious and might be misinterpreted as laziness or lack of motivation by those unfamiliar with mental health issues.

Some of the crucial negative symptoms include diminished emotional expression, such as reduced facial expressions or lack of voice inflection, and avolition, which is a significant reduction in the ability to initiate and persist in goal-directed activities.

• Diminished Emotional Expression: Reduced outward display of emotions.
• Avolition: Difficulty in starting and maintaining activities.
• Anhedonia: Inability to experience pleasure from activities usually found enjoyable.

Negative symptoms are vital to understand because they severely impact an individual's life, making treatment a lifelong and ongoing process.

Typical Antipsychotics

Typical antipsychotics, also known as first-generation antipsychotics, are medications primarily used to treat the positive symptoms of schizophrenia. Introduced in the 1950s, they work mainly by blocking dopamine D2 receptors. Due to their focus on dopamine pathways, these drugs often have limited effects on negative symptoms.

While effective for combating hallucinations and delusions, typical antipsychotics can have side effects, such as tardive dyskinesia, a condition involving involuntary muscle movements, and extrapyramidal symptoms, which include tremors and rigidity.

• Primary Targets: Address positive symptoms such as hallucinations and delusions.
• Common Drugs: Haloperidol, chlorpromazine, and thioridazine.
• Known Side Effects: Tardive dyskinesia, extrapyramidal symptoms.

While sometimes necessary to control severe symptoms, their side effects require careful management to maintain a patient's quality of life.

Atypical Antipsychotics

Atypical antipsychotics, or second-generation antipsychotics, address both the positive and negative symptoms of schizophrenia. Developed in the 1990s, these medications offer a broader therapeutic impact compared to typical antipsychotics by affecting serotonin as well as dopamine receptors in the brain.

Atypical antipsychotics can improve emotional engagement, motivation, and overall function, addressing the broader spectrum of schizophrenia's impacts. However, they also come with their own range of potential side effects, including weight gain and metabolic issues.

• Dual Action: Treat both positive and negative symptoms.
• Common Drugs: Risperidone, olanzapine, and clozapine.
• Potential Issues: Weight gain, metabolic syndrome.

When choosing a treatment plan, healthcare providers weigh these factors to optimize patient outcomes and quality of life.