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Antipsychotics: Classification and Side Effects – Psychiatry | Lecturio
[ Music] antipsychotic therapy and pharmacology is an essential topic let’s go over the highlights here so antipsychotics are drugs also known as neuroleptics and they are categorized in terms of conventional and atypical they act by obstruct dopamine receptors and thereby reduce psychotic symptoms these are used to treat psychotic illness and too psychosis that starts along with other ailments so throughout the lecture serial you’ve learned that psychosis can actually appear as a evidence of severe depression it can also come up during times of dementia so there are a lot of uses for antipsychotics and they can occur in other patients who don’t merely have a primary psyche insane illnes as well so let’s go through the two types usual and atypical well a few examples of ordinary neuroleptics include chlorpromazine thyroid is een haloperidol a typical examples are things like risperidone and ziprasidone so the normal neuroleptics these are d2 dopamine antagonists they have a quite high authority now a normal neuroleptics do annoy dopamine however their lower authority for that and we are really too will target serotonin and histamine receptors as well the typical neuroleptics tend to be really good at analyse positive evidences but the atypicals are actually better at considering the negative evidences which we think of as the merits of the psychotic manifestations ordinary neuroleptics because of their dopamine siege they can really justification a great deal of extrapyramidal side effects that doesn’t happen just as much with the atypical neuroleptics nonetheless these are more likely to cause side effects like sedation and also weight gain or metabolic questions when it comes to the conventional neuroleptics there are again two subtypes there’s the high capacity normal neuroleptics and too low-toned capacity conventional neuroleptics so we’ll talk a little more about those last-minute and for the atypical Nora as I said before these tend to not only block dopamine but they likewise have a strong affinity for serotonin alpha receptors histamine receptors as well in serotonin so the antipsychotics basically again these target dopaminergic neurons that’s really the key and there are a few different dopamine pathways that you should be familiar with the nigrostriatal the Me’s a limbic and the tubero infundibular now neuroleptics are highly overweight soluble and therefore there are a lot of options for returning these intramuscularly or through an dose we’re gonna review that later but as a teaser it’s important to know that when it comes to taking an antipsychotic medication sometimes patients are very fomented in the hospital setting and it’s really nice to have the option to do an insertion of remedy likewise some people don’t like taking a pill every day and the longacting injectable antipsychotics actually allows users by monthly or monthly dosing which can be a nice option for cases so there are a lot of different squanders for antipsychotic prescriptions some are of course the primary psychotic diseases too mood conditions like mania and depression and Tourette’s disorder they can also be helpful there so let’s talk a little more about the conventional antipsychotics and let’s start with the low-pitched effectivenes wands so these have a little bit of a lower affinity for the dopamine receptor and patterns include cor promazine and thioridazine now there’s a higher incidence of anticholinergic influences with these remedies and a lower incidence of the extrapyramidal side effects that can be very upsetting to patients also a little of a lower incidence of neuroleptic malevolent syndrome which can be a deadly side effect of antipsychotic prescription the high capacity conventional antipsychotics have a very high affinity for dopamine siege and these include haloperidol flu phenazine and some other examples listed here there’s a very high incidence of EPS or extrapyramidal indications with these medications and also neuroleptic malignant illnes lower incidence of anticholinergic and antihistamine troubles so what are extrapyramidal side effects you might be wondering so it’s very important to know for your cards so extrapyramidal side effects come from dopamine blockade often through that nigrostriatal pathway and a very early ratifies of this can be acute dystonia now this might attest in your case as something like an oculogyric crisis where their seeings kind of roll up in their honcho it can also be seen as torticollis or next stiffness and acute dystonia can be very distressing to a patient and it can occur immediately or within hours next another eps evidences is brady kinesia or parkinsonian indications so this can look like masked facies where person doesn’t have a lot of expression it can also look like cogwheel rigidity which you might test for when you’re doing your physical exam on a patient some patients have this brady kinesia or hindered changes and they also can have a gate where they do something which is called turning on block meaning that they will make a sudden stop and then turn their entire body so it’s not very easy for them to shift and maneuver as it is for the rest of us they may also get a tremor which can be a cardinal peculiarity of a parkinsonian side effects from this prescription another difficulty that can occur within months of starting an antipsychotic medication is akathisia this is highly distressing to patients so what akathisia is is it’s an internal feel of restlessness it will often evident as a patient pacing perhap sounding their foot or their hand on their leg they’ll often describe to their doctor that they just feel like they want to crawl out of their surface so that’s a sign of a Cathie’s which again is very distressing and then a really important side effect of antipsychotics to be informed about is tardive dyskinesia now it can take times and even decades for a patient to develop tardive dyskinesia a little pearl for your quiz is that elderly Caucasian ladies her hat highest risk for developing tardive dyskinesia when they’re is dealing with an antipsychotic so what this actually looks like is abnormal shifts for example of somebody’s face you may see someone fastening their tongue out frequently or smacking their cheeks together this can also occur less frequently in boundaries or truncal areas and the really unfortunate thing about tardive dyskinesia is that in most cases it’s actually not reversible so it can be very permanent and a disfiguring side effects both traditional and atypical neuroleptics have similar efficacies in terms of treating positive indications of psychosis now you might remember the positive indications of psychosis or things like hallucinations hallucinations bizarre actions however when it comes to treating the negative symptoms of psychosis things like having a flat influence little motive good vigour speech alodia that’s better treated with one of the newer antipsychotics or atypical antipsychotics so the traditional antipsychotic side effects to review them are anti dopaminergic anti ham which we’ll go over that in more detail in a minute of course tardive dyskinesia and dystonia or in other words the EPS symptoms including brady kinesia and akathisia neuroleptic malignant illnes which we’ll talk about in more details too a serious side effect so in terms of tardive dyskinesia we spoke it before but another little pearl to know this is riding movements of the mouth and tongue when your patient is described as having that judge tardive dyskinesia the anti dopaminergic sideeffects is certainly the extrapyramidal symptoms too hyperprolactinemia and this is due to interference of dopamine in the tubero infundibular pathway so cases have been able to end up with so much dopamine blockade that they get a surge in prolactin and this can manifest is actually lactation from the breast and it can occur in women but also in men and then neuroleptic malevolent disorder is another extremely noteworthy sideeffect to look out for so I mention anti ham side effects before well let’s talk about that aims so that H is antihistamine where patients can become very sedated the a is anti alpha adrenergic side effects this can look like worth a static hypotension cardiac arrhythmias and sex dysfunction the anti muscarinic side effects include baked lip tachycardia urinary retention misty vision and constipation all things that are of course undesirable to your case they may also get force income promoted liver enzymes they may have eye difficulties or off the malla reasoning problems dermatological problems and seizures and because tardive dyskinesia is so incredibly important in a potentially irreversible and deforming side effects we’re mentioning it a good deal here it’s really important to be informed about for your quiz and it’s really important to note that it can lead to that permanent disfiguration if you have a patient showing signs of tardive dyskinesia you really want to consider lowering their dose of antipsychotic giving them a drug holiday from their antipsychotic or switching them to another worker preferably an atypical antipsychotic[ Music]
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Rewiring the Anxious Brain – Neuroplasticity and the Anxiety Cycle(Anxiety Skills #21)
So here is the amazing thing about your ability, it’s made to rewire itself all the time. This is called neuroplasticity. Scientists believed that after childhoodour ability was pretty much locked in place, but now that we have better likeness technology, we are able to literally see how the brain deepens depending on how we use it. So, in this video I’m going to talk aboutone very simple thing you can do to rewire your brain to be less watchful, and it is simple, but it’s not easy.So I’m also going to share three steps youcan take to make it happen, and share ten extra skill you can develop on your own, orwith a therapist, to build up your ability to take control of your feeling. And if you would like to learn more in depthinformation about how analyse your nervousnes, I’ve got a course on Udemy that I am workingon called Rewiring the expectant brain, so you are able to check out that tie-in in the description. So, let’s start off with one example of neuroplasticity. In London the taxi moves have this superdifficult exam where they have to prepare by learn all of the streets and eventsand places in this huge city.Researchers took portraits of their ability beforethey started studying, and after this two year process and they only literally ableto see the brand-new neural connects, the wire that changed in the intelligence. And there’s good evidence that changing howyou think, like going to therapy, can actually change the structure of your psyche and thetypes of chemicals that it’s running out. Our brain has an amazing ability to rewireitself to learn, flourish, and mend. So, let’s talk about how to do that with tension. If we want to change how our brain processesanxiety, we need to understand three principles of anxiety. Number 1, we need to understand what is anxiety. Now, this may sound dumb, because you alreadyknow what anxiety feels like, but what you need to do is understand your perspectiveon anxiety. You need to let go of the relevant recommendations that anxietyis bad. Anxiety is not inherently bad. Anxiety is disagreeable, some times anxietyis illness, sometimes nervousnes does in accordance with the arrangements, but we all experience anxiety becauseit is supposed to serve a really important function.To motivate us to avoid real danger. We’re supposed to feel expectant when standingon a cliff hem, it helps us be safe. We’re supposed to feel desirous when we knowwe have an important test coming up because that should cause us to study. Anxiety tells us that something is importantto us. Anxiety and hullabaloo are basically the samechemical reaction in your organization with adrenaline triggering that affectionate activating andprepping you for action. When we look at anxiety as unpleasant, but acceptable and a regular part of life, unexpectedly we develop new tools to work withit, and that includes working with the other type of anxiety.So, the second thing we need to understandis we need to understand ailment distres. And this is when anxiety seems to take overyour life. This is anxiety that establishes it hard to go towork, to clas, or to enjoy life at all. And the harder you try to make it go away, the stronger and stronger it gets. Now, contrary to popular belief, that anxietyis agitation when it is more severe, anxiety is actually ailment when one of two thingshappen. When, number one, when you feel endanger whenyou are actually safe, and I made a video on this, it’s called perceived vs. actualsafety. For illustration I is cooperating with a patron who wasafraid of radiators. She would feel anxious and sweaty around themand she couldn’t represent herself go into a chamber with a radiator in it , now radiators are not actuallydangerous, but she was having a real, physiological response to something that was actually safe. So tension can be illness when you havea danger response in your form, but you are actually safe.The second mode feeling is likely to be disease is when your tension interferes with your ability to function. This is essentially what determines if youmeet the criteria for an anxiety disorder diagnosis. When your nervousnes, or your attempts to avoid anxiety stop you from effectively facing life. When this happens you start avoiding school, or calling in sick to work. You stop leaving the house, or spend timewith friends, pretty soon your feeling is taking over your life and stopping you fromdoing the things you desire. So causes talk about what causes anxiety to coiling out of control. This is called the anxiety cycle. Every day throughout our daytime “were having” events and we understand these experiences as either being safe or dangerous.So make say for example you determine a dog. Now, each person performs an experiencedifferently, for some people this would be extincting and fun, but for some reason youthink, that dog is going to bite me! This leads to feelings of horror, anxiety, maybeeven panic. These are unpleasant feelings and you may even make them as a clue that your thoughts are true. So, you escape, you run away, you get outtathere.And, Nothing bad happens. So your brain liberates this flood of easing, Whew! That was close! The only way I subsisted was because I ranaway. I could have died! And your intelligence judges I better do that again, I’m going to make make human avoid that situation by increasing their anxiety about it. And, vola! your nervousnes goes up. Every single time that we bypass a threat andsurvive, our mentality conceives, Let’s do that again. So it lays down neural pathways, this wiringthat reinforces that behavior. And the whole function of affections is to motivateus to action, but that’s a whole other video. So our mentality, because we have persuasion itthat the dog was a threat, it shall take such action into it’s own hands and it increases you anxietylevels around dogs.Every term we feel suspicion, and then avoidthe situation, our nervousnes height will go up a notch. So this is principle number three, avoidancefeeds illness suspicion. It literally originates devastating feeling. Now, there are lots of ways to avoid. There’s running away, and physically shunning, but there’s also feelings escape, so if you have social anxiety, you might still goto the party, but only if you get drunk ahead of time, or you might be in a relationship, but scared of getting hurt, so you don’t allow yourself to let the other person into yourheart.You stand emotionally remote, or you protectyour self by not dedicating. social media, rage, denounced, distraction, andeven coping sciences, can be avoidant. Regardless of the type of avoidance, it increasesyour nervousnes and, all the more serious, it reduces down your world. So with the dog example, you might start avoiding situations where a puppy might be present, by not going to friend’s homes, or bouncing thepark. And your world contracts, you miss out on goodrelationships, or you stop going to parties.And your world gets more and more restricted. Avoidance can perform your world tiny and scaryand happy. But each time you get anxious and eschewed something, and live, your psyche multiplies your nervousnes in that area. Now, looking at this cycles/second, “were having” two placeswhere we can intervene. Where we can stop that anxiety from spiralingout of control. The first place is with our actions.When we feel suspicion, but we are actuallysafe, if we stick with it, if we stay there, we experience our ardours and sensationswith out running away, and again, if you do this, and you don’t die, then your psyche learnswhew! what a comfort! I guess that not all pups are dangerous, let’sdo that again! And it sends out a surge of succour. This leads to a gradual decrease in anxietyover time, and a gradual increase in your feelings muscles, your ability to feel sentiments and impressions that are unpleasant, with out needing to escape them all the time. So you to be all right at feeling. As you do this your brain literally lays downnew neuro pathways saying not all bird-dogs are dangerous, I don’t need to be anxious arounddogs. And it literally changes your brain chemistry, liberating less cortisol and adrenaline and other stress hormones.This is the most straight forward way torewire your psyche to have little nervousnes. But, I get it, this is super hard-boiled. If “its been” easy, you would have already doneit. So I’m going to break it down into three bigsteps for you. Now on a line-up greenback, the second place in thiscycle to intervene is with your thoughts. Changing how you think about the dog. And this can be a potent and efficient treatmenttoo, but it can also get really complicated. And it is more efficient before your expectant, ratherthan during. Now I can talk about some of the ways youcan change your thinking in other videos, but in this video we’re going to talk abouthe most straight forward way to rewire your expectant intelligence and that’s through your wars. So, how to get it on. There are three steps. So step one, make an exposure hierarchy, I’ve made and entire video about this, but mostly you take one thing that scares you and youbreak it down into teeny minuscule paces, and you start by courageously facing the easiest onefirst.Now this is the part that most people miss. They jump in too fast and then they panicor the flee and they never make love again, and then that fright is reinforced. So make and exposure hierarchy and write downas countless teeny little steps as you can think of. Step two, deepen your rules. Now, spirit doesn’t mean the absence of fear, but preferring that something is more important that by-passing panic. In acceptance and commitment therapy, thisis called willingness. Allowing yourself to do something even thoughit makes you awkward. If you make a rule for your ego like, I’mgoing to do this until I get too watchful, then you brain will be like cool, let’s dothat, then I can escape. So it will constitute you really anxious, and whenwe say I’m going to do this thing unless in reaches me desirous, then we are just invitinganxiety to make all of our decisions for us. So when it comes to exposure, you choose aneasier activity to start with and then you stay with it and watch yourself for a certainamount of time, or until your nervousnes increases by half during the exposure.Now, while you’re facing your nervousnes andpracticing your willingness, footing works, and selfregulation activities, this bodyupapproach to weakening feeling can be useful. But the most important part is that you sitwith your feeling for a little while until it declines, or at least for a certain setamount of duration. Now, step three. Do it. Face it. Go get anxious and see if you live. A little spoiler alerting here, you will. So with the dog example, start be repeatedlyimagining yourself interacting with a pup and you rule every day for ten minutesuntil that activity no longer originates you very anxious.And then you might want to work with a friendwho has a dog to set up the nest paces. So you might check a hound through a window andjust stay there and you sit with it and you breath with it and you allow your self torelax and you do this every day for ten minutes until your nervousnes reduces. And then you pattern being in the same roomwith a insignificant puppy on a leash, and the perhaps touching a tiny dog on a leash and then pettinga tiny dog on a leash and eventually you are moving up to a bigger dog and the off a leashthen eventually you get your self to the point where you can go to a pup common, sit down, and stay there for thirty minutes. It’s ok it you feel uneasy. It’s ok if you feel uncomfortable or you sweat, or you shake, or whatever, but you time stick with it. And pretty soon your mentality learns It’s cool, most pups are safe, your ok. And your feeling will decrease. Now again, you can do some physiological groundingactivities while in the midst of your suspicion, but don’t use those as another way to justavoid anxiety.Use those as a highway to practise willingness. This willingness to feel what you are feelingand professed it as being regular, natural and ok. So there’s the simple solution to anxiety. face your suspicions and they will decrease. This may seem too simple, or too absurd, too big of a bounce, so therapist have organized a assortment of ways to break that leap down intoa knot of tiny paces, a bunch of talents that you are eligible to learn to make it easier. If you want to go more in depth into thatlet’s do that. Let’s talk about the more detailed processof how we do this. The specific skills that help us move fromanxiety avoidance to ability over our nervousnes. Because I am trying to cram so much informationinto this topic, I’ve decided to split this video up in to two parts. So check out part two for the ten knowledge youcan develop to help you face your nervousness. Gradual exposure therapy, which is what Ijust described, is a researched backed approached demonstrate to help reduce anxiety and plow anxietydisorders.It does this because it literally changesthe mentality. Rewiring the neuro pathways and changing therelease of substances in the brain. So make sure to check out my part two withthose ten talents to assist you face your frights and if you’d like to learn more in depth informationabout how to treat you anxiety, I’ve got a course on Udemy that I am working on it’scall Rewiring the Anxious Brain, so you can also check out that associate in the description. Now, please share this video, you never know who might benefit from it, thank you for having watching and take care ..
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