New updates in the concept and clinical usage of "mood stabilizers" based on the new report of WPA section on pharmacopsychiatry, June 2012.
http://1.usa.gov/LrRd3E
New updates in the concept and clinical usage of "mood stabilizers" based on the new report of WPA section on pharmacopsychiatry, June 2012.
http://1.usa.gov/LrRd3E
A simple presentation describing medications used in Psychosis.
In this file, you can have a better idea about psychosis, Schizophrenia and their treatment nowadays.
Pharmacology lecture for medical students in English.
Typical antipsychotics and dopamine in psychosis Ann Sparks
Overview of TYPICAL/Second Generation Antipsychotics (Neuroleptics, Classic, Conventional, D2 Receptor Antagonists). Includes an historical context, Dopaminergic (Reward) Pathways, Symptoms of Psychosis, Side Effedts of Typical Antipsychotics, and animations (if they "translate!").
A compiled Power point presentation on "Antipsychotic drugs" suitable for Undergraduate level medical students and also PG students in the subject of Pharmacology.
Lecture 20 from a college level neuropharmacology course taught in the spring 2012 semester by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University. Focus is on the pharmacological treatment of depression.
A simple presentation describing medications used in Psychosis.
In this file, you can have a better idea about psychosis, Schizophrenia and their treatment nowadays.
Pharmacology lecture for medical students in English.
Typical antipsychotics and dopamine in psychosis Ann Sparks
Overview of TYPICAL/Second Generation Antipsychotics (Neuroleptics, Classic, Conventional, D2 Receptor Antagonists). Includes an historical context, Dopaminergic (Reward) Pathways, Symptoms of Psychosis, Side Effedts of Typical Antipsychotics, and animations (if they "translate!").
A compiled Power point presentation on "Antipsychotic drugs" suitable for Undergraduate level medical students and also PG students in the subject of Pharmacology.
Lecture 20 from a college level neuropharmacology course taught in the spring 2012 semester by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University. Focus is on the pharmacological treatment of depression.
lecture 13 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes DSM-IV TR criteria for major depression and bipolar I & II, serotonin, learned helplessness
Understanding Bipolar Disorder: Biopsychosocial Approaches to Mind Body HealthMichael Changaris
Explores psychological, medical and primary care treatment and self-care for bipolar disorder from the biological bases of brain function and medication management to the psychological integrated care and treatment plan for health complexity and bipolar treatment needs.
lecture 28 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes drugs, electroconvulsive therapy
This presentation provides all the relevant information about mental depression and anti-depressants. It will be useful to students of medicine, pharmacology, pharmacy, and pharmaceutical industry.
Current recreational drugs: RX462 Drug Abuse & Society, Spring 2015 Class pre...Brian Piper
These are the presentations from 2nd and 3rd year pharmacy students from semester long projects on a recreational drug of their choosing. Each presentations contains what was currently known (as of spring, 2015) about the history, epidemiology, pharmacokinetics, and pharmacodynamics of a recreational drug of their choosing.
Drug Abuse & Society (RX 462) Presentations-Spring 2014Brian Piper
This includes end of the semester presentations made by 2nd and 3rd year pharmacy students as part of an elective course. Each student was asked to provide information about history, epidemiology, pharmacodynamics, pharmacokinetics, and toxicology. Older "classic" (psilocybin, ayahuasca, crack), newer (JWB-018, mephedrone, MDA) drugs were covered as well as agents that have appreciable use outside the U.S. (desomorphine, areca nut, kava).
Overview of electronic cigarettes including history, components, safety and adverse events, efficacy in smoking cessation, pharmacokinetics and epidemiology. This presentation was originally delivered to 2nd year pharmacy students as part of a two semester class on pharmacology and toxicology.
Examination of Sexually Dimorphic Behavior on the Novel-Image Novel-Location ...Brian Piper
Objectives: Sex differences in object location memory favoring females appear to be a replicable phenomenon but may also depend on the task demands. This investigation evaluated if females outperformed males at both a short (immediate) and long (half-hour) interval between the learn and test condition using a recently developed version of the Novel-Image Novel-Location (NINL) test (Piper et al. 2011, Physiology & Behavior,
103, 513 - 522). Methods: Young-adults (N = 184) completed a standardized handedness inventory and the NINL. Results: Participants assigned to the Immediate and Delayed conditions did not differ in age, sex, or handedness. The NINL total score was higher among females at the Immediate, but not Delayed, interval. However, within the Delayed condition, females excelled at correctly identifying the unchanged items with a similar pattern for the Novel-Location (NL) scale. Conclusions: These findings are consistent with the view that sexually dimorphic performance favoring females in neurocognitive function can also extend to tasks that have a spatial component.
Drug abuse and society drug presentations: Spring 2013Brian Piper
This presentation is on recreational drugs as part of a elective course for 2nd and 3rd year pharmacy students. The instructions were to include what is known about history, pharmacodynamics, pharmacokinetics including common routes of administration, overdose potential, and recent epidemiology.
The class chose some older agents (peyote, LSD, mushrooms, cocaine), others that have only become more popular recently (bath sats, synthetic cannabinoids), and some medical drugs (methylphenidate, oxycontin).
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
3. Bipolar Disorder: General
• Afflicts 1% of the population
• About 30% will develop symptoms before age
20
• High heritability but limited understanding of
pathophysiology
Stahl (2008). Essential Psychopharmacology, p. 711.
4. DIGFAST – Mental Status Exam
• Distractible
• Increased activity/psychomotor agitation
• Grandiosity/Super-hero mentality
• Flight of ideas or racing thoughts
• Activities that are dangerous or hypersexual
• Sleep decreased
• Talkative or pressured speech
Nancy Rappaport, MD
5.
6. ------
---------------
Stahl, S. (2008). Essential Psychopharmacology (3rd ed), p. 457.
7. ------- -------
Stahl, S. (2008). Essential Psychopharmacology (3rd ed), p. 459.
8. Diagnosis of Bipolar
• Bipolar I: • Bipolar II:
– manic episode – hypomanic episode
– depression not – major depressive episode
required – not due to schizophrenia or
– not due to recreational drugs
schizophrenia or
recreational drugs
11. History of Lithium
• Lithium carbonate (Li2CO3) 1912 - 1980
• John Cade, Australian psychiatrist, on giving
lithium to guinea pigs:
– “After a latent period of about two-hours, the animals, although fully conscious
became extremely lethargic and unresponsive to stimuli for one to two hours before
once again becoming timid and active. Those who have experimented with guinea
pigs know to what extent a ready startle reaction is part of their makeup. It was even
more startling to find that after the injection of a solution of lithium carbonate they
could be turned on their backs and that, instead of the usual frantic righting
behavior, they merely lay there and gazed placidly back at him.”
12. Cade’s Case Series (X)
• Case I- “W.B., a male, 51, who had been in a state of chronic manic excitement for 5
years, restless, dirty, destructive, mischievous and interfering, had long been regarded as the
most troublesome patient in the ward. From the start of treatment (March 29, 1948) … he
steadily settled down and in three weeks was enjoying the unaccustomed surroundings of
the convalescent ward (previously confined to chronic ward). He was kept under observation
for 2 months. He remained perfectly well and left the hospital on July 19, 1948”.
• Case VIII-”W.M., a man of 50, was suffering from an attack of recurrent mania, the first of
which he had at the age of 20. The present attack had lasted two months and showed no
signs of abating. He was garrulous, euphoric, restless and unkempt when he started taking
lithium (Feb 11, 1949). Two days later he was reported to be quieter… By the end of two
weeks he was practically normal-quiet, tidy, rational, with insight into his previous
condition.”
• Case IX- “W.S., a powerfully built man of 47 had suffered from recurrent manic phases since
age 25. … On Feb 11, 1949, he commenced taking lithium … He was considerably quieter 2
days later, was working happily in the kitchen … and by the 9th day was practically normal. …
An acquaintance who has known the patient for years reports that he has never seen him as
normal as at present”.
Cade, J. F. J. (1949). Medical Journal of Australia, 2(10), 349-351.
13. Individual Symptom Control with Lithium
ECT
↑ECT
Li
Plac
Schou et al. (1954). J Neurol Neurosurg Psychiatry, 17, 250-260.
14. History of Lithium in U.S.
• 1940-1960s: lithium chloride used as a
substitute for sodium chloride, poisonings
• 1970: FDA approval, gradual increase as
monotherapy
• 2000s – increased use in combos
– Evidence Based Medicine: based on RCTs
– Eminence Based Medicine: based on clinical
experience & expert opinion
15. Adverse Effects of Lithium
• polydipsia/polyuria (70%)
• hand tremor (40%)
• other neuro (40%)
– headache
– concentration/↓memory
• kidney: risk of diabetes insipidus & nephrotoxicity
• thyroid: hypothyroidism/goiter (20%)
Drayton (2011). In DiPiro Pharmacotherapy: A Pathophysiologic Approach.
16. MOA of Lithium
• Diverse effects but therapeutic mechanism
unknown
• Candidates
– Increase 5-HT release
– Inhibits 2nd messenger systems
Effect of lithium on the IP3 (inositol trisphosphate)
and DAG (diacylglycerol) second messenger
system.
Lithium, by inhibiting the recycling of inosital
substrates, may cause the depletion of PIP2
(phosphatidylinositol-4,5-bisphosphate)
and therefore reduce release of IP3 & DAG.
Meltzer, H. (2011). In Lange’s Basic & Clinical Pharmacology, p. 515.
17. Lithium During Pregnancy
• Category D: There is positive evidence of human fetal risk
based on adverse reaction data from investigational or marketing
experience or studies in humans, but potential benefits may
warrant use of the drug in pregnant women despite potential risks.
• Better profile than anti-psychotics or anti-convulsants
• Complex risk to benefit ratio
• Breast feeding is discouraged
Fig from: Sykes et al. (1976). British Medical Journal, 1299.
18. • The reason for their efficacy
in treating bipolar is unknown
but could involve other
targets besides blocking D2/5-
HT2A
• Acute mania: haloperidol
• Depression in bipolar:
quetiapine
Stahl, S. (2008). Essential Psychopharmacology, p. 692.
20. Summary
• Lithium remains a first choice for BP I despite
a narrow therapeutic index
• Drug combinations (Li + anti-psychotics + anti-
convulsants), despite limited clinical
research, are increasingly common
22. National trends in visits with a diagnosis of bipolar disorder as a percentage of total office-based
visits by youth (aged 0-19 years) and adults (aged >= 20 years)
Moreno, C. et al. (2007). Arch Gen Psychiatry, 64, 1032-1039.
Trish Example (1st min): http://www.youtube.com/watch?v=rcl09ztmoDw
23. Reduced Lifespan
(N = 5,036,662)
Male Male Female Female
Life Expectancy Years Life Years Lost
Lost Expectancy
All (Psychiatric 76.5 NA 80.9 NA
History - )
Schizophrenia 57.8 18.7 64.6 16.3
Bipolar 62.9 13.6 68.8 12.1
BP Contributing Factors:
self-care (circulatory), accident,
homicides, suicide
adverse effects?
Laursen (2011). Schizophrenia Research, 131, 101-104.
Editor's Notes
Libby Zion
If person shows 3 of 7 for one-week, than formal evaluation is needed. I is also for Impulsive (Injudicious), F: fast thoughts.
What symptoms of B are present in the video?
Mixed episode involves manic & depressive episodes at the same time!
Hypomania differs from mania in that the former doesn’t involve any functional impairment/hospitalization.
RichardDreyfuss (Jaws) & Carrie Fischer (Star Wars). It is important to rule out other potential conditions including thyroid, seizure, MS.
Cade was working at a time when the only treatments for bipolar were lobotomy and ECT.
Cade mostly experimented with Lithium citrate but also noted that Lithium carbonate was more tolerable. All 10 showed some degree of improvement during treatment although adherence to Li was often a concern when they left the clinic. This was the first treatment for any mental disorder!
Patient is a 43 year old woman. Line is based on blind rating of emotional level and motor actiity. Note short duration effects of ECT and non-effect of placebo. Study conducted in Risskov, Denmark.
Left-lithium carbonate, Right-lithium chloride.
Nephrogenic diabetes insipidus. Thyroid issues are more a concern with long-term therapy. Lithium accumulates in the thyroid. Dehydration can exacerbate above effects.
Lithium levels in breast milk are about 40% of maternal plasma! Data are from a 36 y.o. mother.
Atypical antipsychotics are useful in management of manic episode and in preventing future ones.
Database includes all persons residing in Denmark between 2000 and 2006, using the Danish Civil Registration System (CRS).