Can I just say you've taught me better than any of the professors at my med school? Keep making amazing Content. You are a godsend esp for a broke student like me
in all seriousness, this is by far the best psychopharm med review i have seen on youtube so far. Exactly the format and explanation/style i was looking for as i prepare for my PHMNP praticum.
I have two family members, one with paranoid schizophrenia and one with schizophrenia & bipolar disorder. Its sad how many practitioners will prescribe antidepressants for bipolar not knowing it can cause a manic episode.
nice video. one correction to make - in your anticholinergic side-effects, you have bradycardia; anticholinergics actually cause tachycardia because of excess sympathetic activity
I love your lectures. I want to note that fluvoxamine is not a first line treatment for OCD. It is the only FDA approved treatment for OCD, but it is not superior to other SSRIs. This was a bolded point in the review book, “Memorable Psychopharmacology”.
Thank you! Can you recommend that book? EDIT: "Serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and clomipramine, are the established pharmacologic first-line treatment of OCD." Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC3181958/ (from 2010 though) "First-line pharmacologic treatments consist of selective serotonin reuptake inhibitors (SSRIs)" Source: emedicine.medscape.com/article/1934139-medication
Very clear and helpful. As I understand it, bupropion is a reuptake inhibitor for norepinephrine and dopamine (not serotonin). Also risperidone is sedating in my experience prescribing it. Thanks for the video very helpful
An excellent review and lecture. Well organized and easy to follow for new practitioners. Grateful for such an excellent free review. You taught me more in a few hours than I did in my formal lectures. Thank you so much. PMHNP recent graduate.
Very helpful pearls, thanks Dr. Bolín. It would be better to choose black color in your slides and avoid the background timer sounds, those two things made me feel tired after this amazing lecture.
TCAs are first line for nightmares according to the Sleep wake disorders video. Thought it would be featured here. Just observing and enjoying the lecture.
@PaulBolinMD you wouldn't happen to have this slide show available to print out. Currently in grad school and I am finding this to be the most beneficial to understand psychopharmacology.
I cannot put in words my gratitude to Dr. Bolin. No words, written o spoken could express my gratitude! is there anyway your listeners can help advance this cause? The whole series completely amazing!
As far as I can see on wikipedia, it's a partial agonist on the D2 receptors, which means that even though it is an agonist, it doesn't work as effectively as dopamine. Therefore, I suppose, overall the action of dopamine will be decreased through competetive inhibition. Please correct me if I'm wrong!
Paul, thank you for this video ! I'm not a doctor Nurse or health pro, but I managed to understand every word of your lecture without Google (though I had to interpolate and extrapolate a few terms). P.S. Did Milwaukee win the hockey match ?
Hi, I comment from a patients view here, I have yearly depressions and bipolar 2. It took years to find a working therapy for me, and I must say that Paul is SPOT ON HERE. I medicate with effexor and lamictal at morning, then a small dose of seroquel at evening, and I have a new life, not being disabled anymore. I hardly belive it. And I'm off any benzodiazepines, maybe eating max 20 pills per year now. The advances in the psych meds literally saves life's. Like mine.
OMG, life changing and I'm eager for the next video and I am just a mentally ill panic disorder suicide attempt survivor that's been on some of these but I've used meth to medicate and we'll I'll add. I need help. Why do I want to tty? The video gave me insight into my med cocktail....I need a few changes
Paul Bolin you're a godsend! first off, thank you very much for making these videos. Wanted to point out diazepam is listed as fast acting when its the longest acting benzo and used for alcohol withdrawal ! cheers! #bindoingthis
Atypical psych meds are really no more effective than typical (first generation) ones to the exception of decreasing the chance of tardive dyskinesia; however, TD can still happen with the atypical ones. Atypical psych meds cost a lot more too and cause people to get fat. Note many antipsychotics can cause the brain to shrink after years. It's true.
Is there any place for Dantrolene and Benztropine in the Prevention of neuroleptic malignant syndrome and extra pyramidal symptoms respectively? When Typical Antipsychotics are prescribed, any need to Prevent?
Good question! AFAIK not for prevention but will google this and tell you! EDIT: You can indeed give dantrolene for prevention - but only vs. malignant hyperthermia: "Preoperatively: Dantrium Intravenous and/or Dantrium Capsules may be administered preoperatively to patients judged malignant hyperthermia susceptible as part of the overall patient management to prevent or attenuate the development of clinical and laboratory signs of malignant hyperthermia" Also: It seems like you cannot (should not?) give Dantrolene to prevent NMS; I'll ask my pharma professor if there is any drug in general that can be used to prevent NMS; my guess would be there isn't one as the chance to get NMS is pretty low and since you can never know when it's gonna hit you, your preventive measure would be to take the preventive drug on a regular (daily?) basis.
I asked my pharma professor - she said there is no use of giving dantrolene to prevent NMS and to her knowledge there isn't any drug that can be given to prevent it, quote "[...], haha that would be very nice [...]"
hi! just curious - i thought anicholinergics INCREASE heart rate (they do the oppostive of the parasympathetic nervous system activation), no? what am I missing here Doc? thank you for the excellent video.
You're videos are great. I'm using them for review for my end of rotation exam. My only concern is with Lithium being the first line for bipolar disorders. The books say valproic acid. My preceptor says the same however he prescribes lithium usually. Can you please explain this. Thank you :)
"Lithium remains the most effective treatment preventing relapse and admission to hospital in bipolar I disorder (I)" and "Valproate as monotherapy has limited trial data, is somewhat less effective than lithium in the prevention of relapse. " Source: psychopharmacologyinstitute.com/publication/bipolar-disorder-treatment-guidelines-a-2019-update-2206 EDIT: Canadian guideline, check this one also; dep. on the phase you could use different drugs Source: onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.12609
Paul Bolin, M.D. , but I thought anti-cholinergic would mean slowing the heart rate down which is bradycardia. Kinda like constipation is from slowing peristalsis down. Or is there something paradoxical when it comes to the heart?
@@TheCorrectionist1984 Think like this: adrenergic system = tachycard cuz you need to outrun that freakin tiger; cholinergic system = bradycard cuz you need to be able to relax during the night to get some refreshing sleep; therefore, anti-cholin. = anti-brady = tachy Precisely: M2/M3 CV effect: negative ino-, chrono-, dromotropic & vasodil. (vasodil only if endothelium is intact)
I loved the video but what's with the metronome in the background? Are you trying to hypnotize us? Jk. 😄 But hey, if it helps to learn these meds, hypnotize away.
Sorry for that! I recorded this video when I was in South America and I didn’t have a room with an A/C. As a Minnesotan, I get warm easily so I had the fan on max. The sound you’re hearing is from that.
@@pwbmd Wow! lol, I posted that 3 years ago. I graduated nursing school and have been working as a nurse for the past 2 among Covid since then. But thanks for the videos, as you can see they helped. Much appreciated!
I was kinda expecting something on Serotonin Syndrome. Secondly, what is the association between Tricyclic Antidepressants and Orthostatic Hypotension?
As far as i know it is caused by TCA's (e.g. amitriptylin) alpha-adrenoceptor-antagonismBut at 18:47 Paul says it is due to the anti-cholinerg effects but I can't see how that is the case, shouldn't that result in a hypertensive effect along with tachycardia as mentioned @8:20Anyway thanks for a great review on the mechanism Paul!! Cheers! M
