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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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?
Schizophrenia has nothing to do with the dopamin hypothesis/ myth and depression, nothing to do with serotonin. Psychiatric drugs very quickly cause a chemical imbalance, shrinking and damaging your delicate brain, and shortens your lifespan.
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 :)
Antidepressants are medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression, as well as other conditions.
They aim to correct chemical imbalances of neurotransmitters in the brain that are believed to be responsible for changes in mood and behavior.
Depression Medications (Antidepressants)
These are the most commonly prescribed type of antidepressant.
Serotonin and noradrenaline reuptake inhibitors (SNRIs) are used to treat major depression, mood disorders, and possibly but less commonly attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety disorders, menopausal symptoms, fibromyalgia, and chronic neuropathic pain.
SNRIs raise levels of serotonin and norepinephrine, two neurotransmitters in the brain that play a key role in stabilizing mood.
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They are effective in treating depression, and they have fewer side effects than the other antidepressants.
SSRIs block the reuptake, or absorption, of serotonin in the brain. This makes it easier for the brain cells to receive and send messages, resulting in better and more stable moods.
They are called "selective" because they mainly seem to affect serotonin, and not the other neurotransmitters.