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8# Antipsychotics
1. The dopamine hypothesis of schizophrenia proposes that the disorder is primarily caused by:
Reduced serotonin activity
Excessive dopaminergic activity
Decreased GABA transmission
Glutamate toxicity
Explanation:
Schizophrenia is associated with excessive dopamine activity, especially in the mesolimbic pathway.
2. Drugs that increase dopaminergic activity are most likely to:
Improve negative symptoms
Reduce cognitive impairment
Prevent psychosis
Induce or worsen psychosis
Explanation:
Dopamine-enhancing drugs can precipitate or exacerbate psychosis.
3. The nigrostriatal dopamine pathway is primarily involved in:
Movement control
Reward and motivation
Cognition and affect
Prolactin secretion
Explanation:
Nigrostriatal pathway degeneration causes Parkinson disease; blockade causes EPS.
4. Overactivity of the mesolimbic pathway leads to:
Negative symptoms
Cognitive impairment
Positive symptoms
Hyperprolactinemia
Explanation:
Mesolimbic dopamine overactivity causes hallucinations and delusions.
5. Underactivity of the mesocortical pathway is associated with:
Tardive dyskinesia
Negative and cognitive symptoms
Hyperprolactinemia
Acute dystonia
Explanation:
Mesocortical dopamine deficiency leads to affective flattening and cognitive deficits.
6. Dopamine normally inhibits prolactin secretion via the:
Mesolimbic pathway
Nigrostriatal pathway
Mesocortical pathway
Tuberoinfundibular pathway
Explanation:
D₂ blockade in the tuberoinfundibular pathway causes hyperprolactinemia.
7. Which symptom is classified as a POSITIVE symptom of schizophrenia?
Hallucinations
Flat affect
Avolition
Social withdrawal
Explanation:
Positive symptoms are additions to normal behavior, such as hallucinations and delusions.
8. Which is the BEST example of a hallucination?
Believing others can read your thoughts
Misinterpreting shadows as people
Hearing voices when no one is present
Firm false belief despite evidence
Explanation:
Hallucinations are perceptions without any external stimulus.
9. Typical antipsychotics exert their therapeutic effect mainly by:
Blocking 5-HT₂A receptors
Antagonizing D₂ receptors
Enhancing dopamine release
Blocking NMDA receptors
Explanation:
Typical antipsychotics primarily block D₂ receptors in the mesolimbic pathway.
10. Extrapyramidal symptoms result from dopamine blockade in the:
Mesolimbic pathway
Mesocortical pathway
Tuberoinfundibular pathway
Nigrostriatal pathway
Explanation:
D₂ blockade in the nigrostriatal pathway produces EPS.
11. Acute dystonia is characterized by:
Sustained muscle contractions
Late-onset choreiform movements
Inner restlessness
Muscle weakness
Explanation:
Acute dystonia causes painful, sustained involuntary muscle contractions.
12. Tardive dyskinesia is best described as:
Early and reversible
Acute and dose-dependent
Late-onset and potentially irreversible
Limited to skeletal muscle rigidity
Explanation:
Tardive dyskinesia appears late and may be irreversible.
13. Hyperprolactinemia caused by antipsychotics can result in all EXCEPT:
Galactorrhea
Amenorrhea
Gynecomastia
Hypertension
Explanation:
Prolactin elevation causes reproductive and sexual side effects, not hypertension.
14. Neuroleptic malignant syndrome is characterized by:
Miosis and hypotension
Fever, rigidity, and autonomic instability
Bradycardia and sedation
Euphoria and hyperactivity
Explanation:
NMS is a life-threatening reaction with rigidity, fever, and autonomic dysfunction.
15. Chlorpromazine is associated with which distinctive adverse effect?
Corneal and lens deposits
Agranulocytosis
Severe seizures
Minimal sedation
Explanation:
Chlorpromazine causes ocular deposits and oral discoloration.
16. Atypical antipsychotics differ from typical ones mainly by:
Strong D₂ blockade only
No dopamine blockade
Combined D₂ and 5-HT₂A antagonism
Exclusive serotonin agonism
Explanation:
Atypicals weakly block D₂ and strongly block 5-HT₂A receptors.
17. Atypical antipsychotics improve negative symptoms mainly by:
Increasing prolactin
Blocking nigrostriatal dopamine
Enhancing mesolimbic dopamine
Increasing dopamine in mesocortical pathway
Explanation:
5-HT₂A blockade increases dopamine in mesocortical areas.
18. Clozapine has a uniquely high risk of:
EPS
Agranulocytosis
Ocular toxicity
Bradycardia
Explanation:
Clozapine can cause life-threatening agranulocytosis.
19. Which antipsychotic is associated with significant metabolic syndrome?
Olanzapine
Haloperidol
Chlorpromazine
Fluphenazine
Explanation:
Olanzapine causes weight gain, hyperlipidemia, and hyperglycemia.
20. Compared to typical antipsychotics, atypical agents have:
Higher EPS risk
No effect on positive symptoms
Lower EPS risk and better negative symptom control
No dopamine receptor activity
Explanation:
Atypicals have weaker D₂ blockade and fewer extrapyramidal side effects.