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Antipsychotics, Mood Stabilzers Anxiolytics
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- Опубликовано: 15 авг 2024
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1:01 - Antipsychotic Mechanism
1:58 - Antipsychotics and their Indications
3:30 - Neuroleptic Malignant Syndrome (Typical Antipsychotic Side Effect)
4:18 - Extrapyramidal Symptoms (Typical Antipsychotic Side Effect)
6:19 - Atypical Antipsychotics and their side effects
8:57 - Mood Stabilizers
12:58 - Anxiolytics and Benzodiazepines
We will start with a quick review of some material from my previous video on psychosis. Symptoms of schizophrenia can be broken down into 2 categories, Positive and Negative Symptoms. Positive symptoms include behaviors or sensations that are not normally present. Examples include hallucinations, delusions, and catatonia. These symptoms are thought to be related to an excess of dopamine. I remember this by remembering that “doPamine has a P in it”. So P for Positive and P for Dopamine. Negative symptoms are the absence of normal behavior. Examples include a lack of initiative, diminished speech, disheveled appearance & flat affect. These symptoms are thought to be related to an excess of serotonin. As we will see antipsychotics affect dopamine and serotonin to varying levels.
The indications for this class of drugs includes psychosis (mainly schizophrenia), Mania (mainly bipolar disorder), aggression and Tourette's disease.
Typical Antipsychotics primarily block dopamine receptors in a non-specific manor. Therefore, these drugs work best for positive symptoms, and have little effect on negative symptoms. The non-specific mechanism of the drug also means there are lots of side effects. Some of these medications come in a slow release injectable form so they can be used in non-compliant and aggressive patients. There are a lot of high yield side effects so we will break them down one by one
Neuroleptic Malignant Syndrome (or NMS) is a rare but potentially fatal adverse reaction of typical antipsychotics. It involves fever, altered mental status, rigidity and autonomic instability (such as tachycardia, hypertension, diaphoresis etc.). You may also see elevated myoglobin in blood or urine and elevated Creatine Kinase (CK). One of the ways I think about it is that it looks kinda sorta like Serotinin Syndrome that you can see with antidepressatns. If you see this you have to emergently stop the medication, provide supportive care and consider adding Dantrolene
Extrapyramidal Symptoms (or EPS) are due to blockage of Nigrostriatal dopamine. It can present with a number of different symptoms.
Akasthisia is a general sensation of restlessness
Acute Dystonia is involuntary continuous muscle contractions often of the neck. Another common presentation of acute dystonia is Oculogyris Crisis when your eyes get locked looking upward and you have to lean over to see
Dyskinesia (AKA Pseudoparkinsonism) presents like Parkinson’s Disease with symptoms like a pill rolling tremor, cogwheel rigidity & bradykinesia (or slow movement)
Tardine Dyskinesia (or TD) is uncontrollable facial tics, grimacing & tongue movements
As scary as these symptoms may look, they are generally not medical emergencies. In most cases you will continue to use the drug with perhaps a reduction in the dose or the addition of an anticholinergic mediation like Benzatropine or Diphenhydramine. Tardive Dyskinesia is the exception and requires cessation of the medication as it can be permanent. Usually you would switch a patient with TD to a 2nd gen antipsychotic.
Hyperprolactinemia is a side effect due to Blockage of Tuberoinfundibular dopamine. It presents just like any other disease that increases prolactin. So you can have galactorrhea, gynecomastia, decreased libido and menstrual irregularities.
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very useful for seniors like me. it's a recall and add in daily practice
You're a legend, man. Thanks for this series, UWorld was killing me!
+Nic Miller LOL thanks!
Some of these have saved my life while others made things much worse, and I really appreciate that you have explanations as to why I had adverse reactions on a chemical level. It makes it a lot less scary.
Which one helped you?
@@hafsi2947 Lamotrigine has saved my life. Others have helped along the way, especially when I was severely depressed or suicidal, but Lamotrigine is the one medication I continue to take today. I've tried around 30 meds but lamictal has been the only one to consistently help more than it harms me. Everyone has a different brain chemistry though
BeMeeklez Velveeta Yes it’s good for depression but it will screw your eyesight, cause metabolic syndrome, and just wait until your doctor tells you that you have to come off of it. Lamictal withdrawal..
@@davidbillyard6629 thankfully I won't be on medication forever, I take I until I can learn my own coping mechanisms. My eyesight is taking a big toll from the Lamictal, but for where I was before I took it I'll gladly take it for now honestly
BeMeeklez Velveeta yeah ok. It also will give you gum/teeth problems. Good luck.
Thank you ,sir.. it was awesome and understable...it really help me a lot to be ready at my new job to understand the patient way and thinking....god bless you..sir...
This video helps me a lot thank you very much sir
Greetings from Latvia! Thank you very much for this collection of videos! I would only suggest adding some childhood/adolescent disorders to this list (ADHD, Autism, mental retardation and learning skill specifics as dyslexia, dyscalculia). :) Very nice revision material for the exams :)
Thank you so much sir
your awesome
best explained ever
+haroon saadat Thanks for watching!
+Stomp On Step 1 mood stabilizers are pure poisons whether like it or not.
@@nowaynoway6655 💀
Great video! ♡♡
+lucycare thank you for the kind comment :)
Thank you very much for great video.
You are so awesome! Thank you so much!
Benzos can be used for status epilepticus. I want to see that. Have you made it?
Hard to find out facts on drugs so a person can try to maintain one's health as well.
Hi! Helpful video
I have two questions
Are there any side effects to buspirone, such as insomnia?
Do the side effects of TCA such as cognitive impairment go away? Thanks
i cannot understand why serotonin excess causes negative symptoms..like unhappy symptoms.. when we treat depression or else we give ssri which increases serotonin action..and it is known as happiness hormone..can u please explain?
workouts It is not known or confirmed that serotonin is a happy hormone. the drug makers made that assertion in order to sell drugs
First, negative symptoms are not "unhappy" symptoms. They are referring to the symptoms of schizophrenia that should be there, but aren't. Secondly, the only thing I can think of that has to do with serotonin in relation to schizophrenia is the following: Positive symptoms are thought to be caused by excess dopamine, so typical antipsychotics block the dopamine receptors. While this is good for the positive symptoms of schizophrenia, it is what causes extrapyramidal symptoms. To combat this, atypical antipsychotics block dopamine receptors, but also block serotonin (which inactivates dopamine), so that not as much dopamine is blocked, to remedy the extrapyramidal effects. I don't think it is true to say excess serotonin causes negative symptoms, but I'm far from an expert. Hope this helped, two years later.
Thanks!!!!!
+Chux “PLUR” Thomas thanks for the comments! It really helps me out
Thanks
thankk uuu
Hn 18/4/2020 doubt about my choice.
Thank you!
Chemical lobotomy ...
Damn right it is
2nd gens don't really help with negative symptoms, they just don't cause extrapyramidal symptoms.
Audio quality is bad
Ruined my life with benzos
Sometimes I think I did too with Valium
Now that I take Lamictal I crave valium less and I feel less physically dependant on it, not sure if it's linked but I've nearly weaned off completely now on my own in just a month. And I've taken vals for 3 years at really high doses. Lamictal's kinda starting to seem like a miracle drug for me
@@bemeeklezvelveeta6719 Did Lamictal ever give you disturbing dreams? It did with me. I know what works for one person may work for one person may not for another. I'm glad to hear it is working for you and wish you the best!
Thanks!!!!!!!