Dopamine Abnormalities In Schizophrenia Essay Example Paper
Introduction
Schizophrenia affects around 1% of the U.S. population. Patients usually present with symptoms of schizophrenia during young adulthood, with males presenting earlier in life than females (21 years of age vs. 27 years of age, respectively). (Centers for Disease Control and Prevention 2013) Patients with schizophrenia have a shortened life expectancy compared to the general population, attributed mostly to medical comorbidities such as cardiovascular and cerebrovascular disease. (Gabbard 2014 pg.198) Patients with early-onset schizophrenia (first episode at 13 – 18 years of age) have been found to have poorer outcomes. Early identification of schizophrenia is key to maximize treatment response and to optimize long-term outcomes Dopamine Abnormalities In Schizophrenia Essay Example Paper.
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Antipsychotics are the mainstay in the pharmacological treatment of schizophrenia and other psychotic disorders. Although the largest body of evidence for the use of antipsychotics is for psychotic disorders, many antipsychotics have gained FDA-approved and non approved indications for various mood disorders and behavioral disorders. You will learn about the utility of antipsychotics for the treatment of these other mental health illnesses throughout this semester.
The choice of antipsychotic is generally based on various patient-specific factors: history of response/nonresponse/intolerability, comorbid medical/psychiatric illnesses and sensitivity to potential adverse effects, concurrent medications and potential for drug interactions, cost, and personal preference. Adolescents and young adults are sensitive to the adverse effects of antipsychotics, especially extrapyramidal symptoms, and metabolic changes, and generally respond better to smaller doses. It is important to start with the least noxious drug at the smallest effective dose to minimize risk of side effects Dopamine Abnormalities In Schizophrenia Essay Example Paper.
Each time a patient relapses their risk of having persistent psychotic symptomatology increases. (Gabbard 2014, pg 152) Treatment adherence is a crucial part of preventing relapse in schizophrenia. Being upfront about side effects and treatment expectations and involving caregivers in discussions are important in building trusting relationships with patients, which can help improve adherence. Switching to long-acting injectable medications is a useful treatment consideration for patients who have difficulty remembering to take their medication.
In addition to the antipsychotics listed in Table 11-1, there are two new second-generation antipsychotics that have been recently approved for the treatment of schizophrenia: brexpiprazole (Rexulti) and cariprazine (Vraylar). Another second-generation, pimavanserin (Nuplazid), was approved for the treatment of Parkinson’s Disease psychosis in early 2016 Dopamine Abnormalities In Schizophrenia Essay Example Paper.
The prevailing hypothesis for schizophrenia implicates the neurotransmitter dopamine as playing a key role in the development of the disease. Dopamine acts on several areas of the brain with differing effects. Please outline the key dopamine pathways and the implications of antipsychotic use on each pathway.
Two of the brain’s primary dopaminergic pathways include the mesocortical and mesolimbic pathways. The Mesolimbic pathway links the midbrain’s ventral tegmental area with the forebrain’s ventral striatum of the basal ganglia. The ventral striatum contains the olfactory tubercle and the nucleus accumbens. The mesolimbic pathway’s production of dopamine controls desire and motivation for reward cues and also enhances reassurance and reward-related motor skills development in the brain stem. Thus, the mesolimbic pathway has the potential to affect a person’s personal enjoyment experience. The impairment of the mesolimbic pathway and its projection neurons by the nucleus accumbens serves a key part in the emergence and persistence of psychotic symptoms (McCutcheon, Abi-Dargham & Howes, 2019).
The Mesocortical pathway, on the other hand, connects the ventral tegmentum to the prefrontal cortex. It is essential for appropriate brain performance in the dorsolateral prefrontal cortex and is also implicated in cognitive control, desire, and emotional reaction. In addition, it has a strong link to the mesolimbic pathway. A reduction in dopamine in the mesocortical output to the dorsolateral prefrontal cortex is hypothesized to be the origin of sad and depressed feelings in schizophrenia patients (Weinstein et al., 2017). Nicotine works by producing dopamine in the mesocortical pathways, which alleviates unpleasant sensations Dopamine Abnormalities In Schizophrenia Essay Example Paper.
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Antipsychotic medications reduce the impact of erroneous dopamine release. However, they may worsen the fundamental issue by generating a corrective rise in dopamine production by inhibiting presynaptic D2 auto-receptors. This might illustrate the reason why clients relapse fast after stopping their medicine and why if the meds worsen the fundamental anomaly, patients relapse more severely after stopping therapy.
References
McCutcheon, R. A., Abi-Dargham, A., & Howes, O. D. (2019). Schizophrenia, dopamine and the striatum: From biology to symptoms. Trends in Neurosciences, 42(3), 205-220. https://doi.org/10.1016/j.tins.2018.12.004
Weinstein, J. J., Chohan, M. O., Slifstein, M., Kegeles, L. S., Moore, H., & Abi-Dargham, A. (2017). Pathway-specific dopamine abnormalities in schizophrenia. Biological Psychiatry, 81(1), 31-42. https://doi.org/10.1016/j.biopsych.2016.03.2104
Dopamine Abnormalities In Schizophrenia Essay Example Paper