Schizophrenia Symptoms and Antipsychotic Effects Describe schizophrenia in terms of negative symptoms and the postulated underlying neuronal circuitry responsible for negative symptoms. How do antipsychotics cause prolactin elevation and what are the consequences of elevated prolactin levels? Can this be treated without cessation of antipsychotic therapy? If so how? What is the link between a conventional antipsychotic and the development of neuroleptic-extrapyramidal symptoms and tardive dyskinesia? 

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Requirements

The student must provide the initial substantive response to the discussion question/topic(s) posted by the course faculty by Friday of those weeks with a discussion board assignment.

The student must also provide a minimum of two additional responses to two student colleagues on two different days by Tuesday of those weeks with a discussion board assignment.

Understanding Schizophrenia and Antipsychotic Effects

Negative Symptoms of Schizophrenia

Negative symptoms of schizophrenia refer to the absence or reduction of normal behaviors and emotions. These include:

• Alogia (reduced speech)
• Avolition (lack of motivation)
• Anhedonia (inability to feel pleasure)
• Affective flattening (diminished emotional expression)
• Social withdrawal

These symptoms are often more debilitating than positive symptoms (like hallucinations) and are associated with poor social and occupational outcomes.

Neuronal Circuitry Behind Negative Symptoms

Negative symptoms are believed to arise from dysfunction in the mesocortical dopamine pathway, which connects the ventral tegmental area (VTA) to the prefrontal cortex.

• Reduced dopamine activity in the prefrontal cortex leads to cognitive and motivational deficits.
• Glutamate dysfunction in the prefrontal cortex and limbic regions also plays a role.
• Structural abnormalities such as reduced gray matter volume in the prefrontal and limbic areas contribute to these symptoms.

Antipsychotics and Prolactin Elevation

Some antipsychotics, especially first-generation (typical) antipsychotics and some second-generation (atypical) ones, cause prolactin elevation by blocking dopamine D2 receptors in the tuberoinfundibular pathway.

• Dopamine normally inhibits prolactin release from the pituitary gland. When dopamine is blocked, prolactin levels rise.

Consequences of Elevated Prolactin

• Galactorrhea (abnormal milk production)
• Gynecomastia (breast enlargement in males)
• Menstrual irregularities and infertility in women
• Sexual dysfunction
• Bone density loss due to reduced estrogen/testosterone levels APA