A 21 years old female was brought to psychiatry opd by her parents. According to mother, patient for last one month has been complaining that the neighbours are trying to record her activities and that they have put a camera in her room. She fuher says that two neighbourhood aunts keep on talking about her and make vulgar comments about her. Mother said that she has never heard any such voice and there house is quite separated from neighbours and its impossible that any voice can come to their house. However, patient insists that people are talking about her and some conspiracy is being hatched about her. The patient was diagnosed with schizophrenia and she was put on risperidone 3 mg/day. Patient showed significant improvement in her symptoms however on follow up she complained of milky discharge from nipples. Which of the following brain pathway is responsible for this side effect?
A 21 years old female was brought to psychiatry opd by her parents. According to mother, patient for last one month has been complaining that the neighbours are trying to record her activities and that they have put a camera in her room. She fuher says that two neighbourhood aunts keep on talking about her and make vulgar comments about her. Mother said that she has never heard any such voice and there house is quite separated from neighbours and its impossible that any voice can come to their house. However, patient insists that people are talking about her and some conspiracy is being hatched about her. The patient was diagnosed with schizophrenia and she was put on risperidone 3 mg/day. Patient showed significant improvement in her symptoms however on follow up she complained of milky discharge from nipples. Which of the following brain pathway is responsible for this side effect?
💡 Explanation
**Core Concept**
Schizophrenia is a psychiatric disorder characterized by hallucinations, delusions, and disorganized thinking, often resulting in significant distress and impairment in social and occupational functioning. The patient's symptoms, such as hearing voices and believing in a conspiracy, are typical of the positive symptoms of schizophrenia. Risperidone, an atypical antipsychotic, is commonly used to treat schizophrenia by modulating neurotransmitter systems in the brain.
**Why the Correct Answer is Right**
Risperidone's side effect of galactorrhea (milky discharge from nipples) is due to its antipsychotic properties, which include dopamine D2 receptor antagonism. Dopamine is a key neurotransmitter involved in regulating prolactin release from the pituitary gland. When risperidone binds to dopamine D2 receptors in the pituitary gland, it blocks the inhibitory effect of dopamine on prolactin release, leading to an increase in prolactin levels. Elevated prolactin levels can cause galactorrhea, as well as other symptoms such as amenorrhea and gynecomastia.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is not relevant to the side effect of galactorrhea. The pathway responsible for this side effect is not related to serotonin receptor antagonism.
* **Option B:** This option is not directly related to the side effect of galactorrhea. While the hypothalamic-pituitary-adrenal (HPA) axis is involved in stress response, it is not the primary pathway responsible for risperidone's side effect of galactorrhea.
* **Option D:** This option is not relevant to the side effect of galactorrhea. The pathway responsible for this side effect is not related to histamine receptor antagonism.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that antipsychotic medications like risperidone can cause hyperprolactinemia, leading to side effects such as galactorrhea, amenorrhea, and gynecomastia. Patients on these medications should be monitored regularly for these side effects, and dose adjustments or alternative medications may be necessary to manage them.
**Correct Answer:**
C. The dopamine D2 receptor pathway in the pituitary gland is responsible for the side effect of galactorrhea caused by risperidone.
✓ Correct Answer: C. Tubero-Infundibular tract
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