You are on page 1of 8

Dopamine pathways & antipsychotics

Flavio Guzmán, MD
Pharmacology Instructor Health Sciences Faculty University of Mendoza Argentina

Psychiatry Resident Mental Health Teaching Hospital “Dr. Carlos Pereyra “ Mendoza Argentina

Learning objective • Understand basic concepts of dopaminergic pathways and their relevance to antipsychotic effects. .

Mesocortical pathway (negative symptoms) .Dopaminergic pathways: outline .Nigrostriatal pathway (EPS and TD) -Tuberoinfundibular pathway (hyperprolactinemia) .Mesolimbic pathway (positive symptoms) .

Mesolimbic pathway & positive symptoms of schizophrenia Anatomy • Projections from the ventral tegmental area (VTA) to the nucleus accumbens. reward . emotions. positive symptoms of schizophrenia Implications • D2 antagonists reduce positive symptoms of schizophrenia. . Physiology • Motivation.

Implications • Hypofunction of the mesocortical pathway might be related to cognitive and negative symptoms in schizophrenia . Physiology • Cognition and executive functions (DLPFC). emotions and affect (VMPFC).Mesocortical pathway: negative & cognitive symptoms Anatomy • Projections from the ventral tegmental area (VTA) to the cortex (PFC).

Implications • D2 antagonism induces extrapyramidal symptoms (pseudoparkinsonism) . Physiology • Stimulation of purposeful movement.Nigrostriatal pathway & EPS Anatomy • Projections from substantia nigra (pars compacta) to striatum (caudate and putamen).

Physiology • Dopamine is released into the portal circulation connecting the median eminence with the anterior pituitary gland. Implications • D2 antagonism increases prolactin levels. .Tuberoinfundibular pathway & prolactin release Anatomy • Hypothalamus (arcuate and periventricular nuclei) to infundibular region (median eminence). • Dopamine tonically inhibits prolactin release.

• Hypofunction of the mesocortical pathway might in part explain cognitive and negative symptoms of schizophrenia. . • D2 blockade of the nigrostriatal pathway can cause EPS. • D2 blockade of the tuberoinfundibular pathway increases prolactin blood levels.Summary • Hyperactivation from the VTA to limbic areas might be related to positive symptoms of schizophrenia.