Dopamine auditory hallucinations

Extension of this specificity principle to the clinical domain has resulted in the availability of increasingly well-aimed chemical bullets. If we wanted to block just one of the many serotonin receptors to see what would happen, we could probably do it But if we wanted to elevate mood in depression—or obsessive-compulsive disorder—would we expect the best result if we blocked just that one receptor And if we wanted to discourage auditory hallucinations in schizophrenia, would we want our drug to target only D2 dopamine receptors, even if we knew that the antipsychotic action of drugs correlated well with a drug s affinity for those receptors ... 

The psychosis that least resembles dreaming is that of schizophrenia, because, like mania, it has the paranoia and accusatory auditory hallucinations (which dreaming lacks), and the emotional tone is often flat (about as far away from dream elation as we can get). Anxiety is about the only shared property, and that is not very specific. Perhaps it should come as no surprise that the typical schizophrenic psychosis is so different from that of dreaming. After all, it is the neuromodulator dopamine that has been most strongly implicated in the pathogenesis of schizophrenia, and that is the only neuromodulator that has not been implicated in dreaming. We will discuss this interesting difference in more detail when we consider how antipsychotic medication may work. 

The hypothetical link between dopamine and schizophrenia was forged by two reciprocally related findings. The first was that potent dopamine agonist stimulants like d-amphetamine and cocaine could cause a psychosis that was schizophrenia-like, in that it had auditory hallucinations and paranoia. The second was that the neuroleptic drugs that were effective in reversing both schizophrenia and stimulant-induced psychosis were dopamine blockers. Moreover, the antipsychotic potency of the neuroleptics was proportional to their binding affinity to the D2 receptor. 

The mesolimbic dopamine pathway projects from dopaminergic cell bodies in the ventral tegmental area of the brainstem to axon terminals in limbic areas of the brain, such as the nucleus accumbens (Fig. 10—8). This pathway is thought to have an important role in emotional behaviors, especially auditory hallucinations but also delusions and thought disorder (Fig. 10—9)-... 

I younger adult receiving the antiparkinsonism drugs especially when taking the dopamine receptor agonists The nurse should assess the older adult for sgns of visual, auditory, or tactile hallucinations The incidence of halludnationsappears to increase with age. 

A 52-year-old woman on long-term treatment with benzodiazepines experienced confusion and auditory and visual hallucinations within 2 days of starting to take kava (Cartledge and Rutherford 2001). Several case reports of possible dopamine antagonism suggest that kava may interact with central dopamine agonists or antagonists (Mills and Bone 2005 Schelosky et al. 1995). 

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