Antipsychotics, also known as neuroleptics,[1] are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders.[2][3] They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.[4]
Antipsychotic
Drug class
Zyprexa.PNG
Olanzapine, an example of a second-generation (atypical) antipsychotic
Class identifiers
Synonyms
Neuroleptics, major tranquilizers[1]
Use
Principally: Schizophrenia, Schizoaffective disorder, Dementia, Tourette syndrome, Bipolar disorder, irritability in autism spectrum disorder
Clinical data
Drugs.com
Drug Classes
External links
MeSH
D014150
In Wikidata
Prior research has shown that use of any antipsychotic is associated with smaller brain tissue volumes,[5][6] including white matter reduction[7] and that this brain shrinkage is dose dependent and time dependent.[5][6] A more recent controlled trial suggests that second generation antipsychotics[8] combined with intensive psychosocial therapy[9] may potentially prevent pallidal brain volume loss in first episode psychosis.[10][7]
The use of antipsychotics may result in many unwanted side effects such as involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce adverse effects such as tardive dyskinesia, tardive dystonia, and tardive akathisia.
Prevention of these adverse effects is possible through concomitant medication strategies including use of beta-blockers. Currently, treatments for tardive diseases are not well established.
First-generation antipsychotics (e.g. chlorpromazine), known as typical antipsychotics, were first introduced in the 1950s, and others were developed until the early 1970s.[11] Second-generation antipsychotics, known as atypical antipsychotics, were introduced firstly with clozapine in the early 1970s followed by others (e.g. risperidone).[12] Both generations of medication block receptors in the brain for dopamine, but atypicals tend to act on serotonin receptors as well. Neuroleptic, originating from Greek: νεῦρον (neuron) and λαμβάνω (take hold of)—thus meaning "which takes the nerve"—refers to both common neurological effects and side
Health Conditions
Health Conditions
Alzheimer's & Dementia
Anxiety
Arthritis
Asthma & Allergies
Breast Cancer
Cancer
Cardiovascular Health
COVID-19
Dermatology & Skincare
Diabetes
Environment & Sustainability
Exercise & Fitness
Eye Health
Headache & Migraine
Health Equity
HIV & AIDS
Human Biology
Inflammatory Bowel Disease
Leukemia
LGBTQIA+
Men's Health
Mental Health
Multiple Sclerosis (MS)
Nutrition
Parkinson's Disease
Psoriasis
Sexual Health
Women's Health
Health Products
Health Products
Nutrition & Fitness
Vitamins & Supplements
CBD
Sleep
Mental Health
At-Home Testing
Men’s Health
Women’s Health
Discover
News
Latest News
Original Series
Medical Myths
Honest Nutrition
Through My Eyes
New Normal Health
Podcasts
How Viagra became a new 'tool' for young men
What makes breast cancer come back?
How to understand chronic pain
What is behind vaccine hesitancy?
The amazing story of hepatitis C, from discovery to cure
New directions in dementia research
Tools
General Health
Drugs A-Z
Health Hubs
Health Tools
BMI Calculators and Charts
Blood Pressure Chart: Ranges and Guide
Breast Cancer: Self-Examination Guide
Sleep Calculator
Quizzes
RA Myths vs Facts
Type 2 Diabetes: Managing Blood Sugar
Ankylosing Spondylitis Pain: Fact or Fiction
Connect
About Medical News Today
Who We Are
Our Editorial Process
Content Integrity
Conscious Language
Newsletters
Sign Up
Follow Us
Health Conditions
Health Products
Discover
Tools
Connect
SUBSCRIBE
All about antidepressants
Types
Side effects
Uses
Efficacy
Choosing
In pregnancy and nursing
Alternatives
How they work
Taking effect
Treatment duration
Summary
Antidepressants can help relieve the symptoms of depression. They can also help to treat social anxiety disorder, other anxiety disorders, and seasonal affective disorder.
They work by correcting chemical imbalances of neurotransmitters in the brain. Experts believe these are responsible for changes in mood and behavior.
This article will cover the different types of antidepressants, how they work, their side effects, other uses, and alternative options.
Types
blackCAT/Getty Images
Doctors tend to divide antidepressants into different types. These include:
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a first-line treatment option for depression.
Examples of SSRIs include:
citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac, Sarafem)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SNRIs are a newer class of antidepressant compared with SSRIs. However, they work in a similar way.
Doctors may prescribe SNRIs for:
attention deficit hyperactivity disorder (ADHD)
obsessive-compulsive disorder (OCD)
anxiety disorders
menopausal symptoms
fibromyalgia
chronic neuropathic pain
Examples of SNRIs include:
duloxetine (Cymbalta)
venlafaxine (Effexor XR)
desvenlafaxine (Pristiq)
Tricyclic antidepressants (TCAs)
Doctors may recommend TCAs for depression, fibromyalgia, some types of anxi
Health Conditions
Health Conditions
Alzheimer's & Dementia
Anxiety
Arthritis
Asthma & Allergies
Breast Cancer
Cancer
Cardiovascular Health
COVID-19
Dermatology & Skincare
Diabetes
Environment & Sustainability
Exercise & Fitness
Eye Health
Headache & Migraine
Health Equity
HIV & AIDS
Human Biology
Inflammatory Bowel Disease
Leukemia
LGBTQIA+
Men's Health
Mental Health
Multiple Sclerosis (MS)
Nutrition
Parkinson's Disease
Psoriasis
Sexual Health
Women's Health
Health Products
Health Products
Nutrition & Fitness
Vitamins & Supplements
CBD
Sleep
Mental Health
At-Home Testing
Men’s Health
Women’s Health
Discover
News
Latest News
Original Series
Medical Myths
Honest Nutrition
Through My Eyes
New Normal Health
Podcasts
How Viagra became a new 'tool' for young men
What makes breast cancer come back?
How to understand chronic pain
What is behind vaccine hesitancy?
The amazing story of hepatitis C, from discovery to cure
New directions in dementia research
Tools
General Health
Drugs A-Z
Health Hubs
Health Tools
BMI Calculators and Charts
Blood Pressure Chart: Ranges and Guide
Breast Cancer: Self-Examination Guide
Sleep Calculator
Quizzes
RA Myths vs Facts
Type 2 Diabetes: Managing Blood Sugar
Ankylosing Spondylitis Pain: Fact or Fiction
Connect
About Medical News Today
Who We Are
Our Editorial Process
Content Integrity
Conscious Language
Newsletters
Sign Up
Follow Us
Health Conditions
Health Products
Discover
Tools
Connect
SUBSCRIBE
All about antidepressants
Types
Side effects
Uses
Efficacy
Choosing
In pregnancy and nursing
Alternatives
How they work
Taking effect
Treatment duration
Summary
Antidepressants can help relieve the symptoms of depression. They can also help to treat social anxiety disorder, other anxiety disorders, and seasonal affective disorder.
They work by correcting chemical imbalances of neurotransmitters in the brain. Experts believe these are responsible for changes in mood and behavior.
This article will cover the different types of antidepressants, how they work, their side effects, other uses, and alternative options.
Types
blackCAT/Getty Images
Doctors tend to divide antidepressants into different types. These include:
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a first-line treatment option for depression.
Examples of SSRIs include:
citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac, Sarafem)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SNRIs are a newer class of antidepressant compared with SSRIs. However, they work in a similar way.
Doctors may prescribe SNRIs for:
attention deficit hyperactivity disorder (ADHD)
obsessive-compulsive disorder (OCD)
anxiety disorders
menopausal symptoms
fibromyalgia
chronic neuropathic pain
Examples of SNRIs include:
duloxetine (Cymbalta)
venlafaxine (Effexor XR)
desvenlafaxine (Pristiq)
Tricyclic antidepressants (TCAs)
Doctors may recommend TCAs for depression, fibromyalgia, some types of anxi
Schizophrenia is a serious mental illness that affects how a person thinks, f...AmitSherawat2
Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family a
Major depressive disorder(MDD) is a disorder of mood in which the individual experiences one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes.
2
Running head: Schizophrenia
Schizophrenia
Classes of drugs used to treat schizophrenia
The most significant common medication used in the treatment of schizophrenia is antipsychotic medication. There are two types of drugs that are typical and atypical, both work to reduce the positive or negative effects of schizophrenia. Antipsychotic drugs are used to treat mental, emotional and psychosis conditions. Psychosis refers to the state in which an individual loses touch with reality; the individual starts having hallucinations or delusions.
To alleviate the problem antipsychotic drugs are used to regulate the levels of neurotransmitters in the brain.
Explain their action at the neurotransmitter system.
Schizophrenia is linked to changes in the activities of the neurotransmitter in some specific parts of the brain. Antipsychotic medication affects this neurotransmitter affecting their activity too. The medication acts by interfering with the chemical messengers and controlling or lessening the symptoms of the disorder like mood swings, hallucinations, and delusions. There are mainly two types of antipsychotic drugs that is typical and atypical antipsychotic drugs.
They work by altering dopamine and serotonin receptors. Typical antipsychotics or first generation psychotics were manufactured first in the 1950s. Its function is to block dopamine receptor known as a D2 receptor. Atypical antipsychotics or the second generation antipsychotics were introduced in the 1990s. Just like typical antipsychotic, they block D2 receptors as well as a serotonin receptor known as a 5-HT2A receptor.
Analyze and describe the agonist-antagonist activity of the drugs and the receptor types and subtypes involved in the disorder.
Partial agonists have a lower rate of activity than full agonists at the receptors. This allows them to function as either a functional agonist or functional antagonist depending on the levels of the neurotransmitter (full agonist). If a neurotransmitter is not present partial agonist display a functional antagonist activity. This is as a result of receptor binding reducing any response with the neurotransmitter.
Partial agonist in dopamine D2 receptors is an alternative option when treating schizophrenia. It acts as a functional antagonist mesolimbic dopamine pathway, and the excessive dopamine activity causes positive symptoms. However, reduced dopamine activity in the mesocortical pathway causes cognitive impairment and negative symptoms.
Elaborate on the receptor agonist-antagonist actions of the drugs and describe the most common side effects seen with these drugs.
Inhibition of dopamine function is the most common feature of antipsychotic drugs. D4 receptor activation in moderate levels helps antipsychotic agents protect the brain from negative and cognitive symptoms of schizophrenia. D2 and D3 receptors help improve positive symptoms of schizophrenia but are not successful in countering negative and cognitiv.
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
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.
Schizophrenia is a serious mental illness that affects how a person thinks, f...AmitSherawat2
Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family a
Major depressive disorder(MDD) is a disorder of mood in which the individual experiences one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes.
2
Running head: Schizophrenia
Schizophrenia
Classes of drugs used to treat schizophrenia
The most significant common medication used in the treatment of schizophrenia is antipsychotic medication. There are two types of drugs that are typical and atypical, both work to reduce the positive or negative effects of schizophrenia. Antipsychotic drugs are used to treat mental, emotional and psychosis conditions. Psychosis refers to the state in which an individual loses touch with reality; the individual starts having hallucinations or delusions.
To alleviate the problem antipsychotic drugs are used to regulate the levels of neurotransmitters in the brain.
Explain their action at the neurotransmitter system.
Schizophrenia is linked to changes in the activities of the neurotransmitter in some specific parts of the brain. Antipsychotic medication affects this neurotransmitter affecting their activity too. The medication acts by interfering with the chemical messengers and controlling or lessening the symptoms of the disorder like mood swings, hallucinations, and delusions. There are mainly two types of antipsychotic drugs that is typical and atypical antipsychotic drugs.
They work by altering dopamine and serotonin receptors. Typical antipsychotics or first generation psychotics were manufactured first in the 1950s. Its function is to block dopamine receptor known as a D2 receptor. Atypical antipsychotics or the second generation antipsychotics were introduced in the 1990s. Just like typical antipsychotic, they block D2 receptors as well as a serotonin receptor known as a 5-HT2A receptor.
Analyze and describe the agonist-antagonist activity of the drugs and the receptor types and subtypes involved in the disorder.
Partial agonists have a lower rate of activity than full agonists at the receptors. This allows them to function as either a functional agonist or functional antagonist depending on the levels of the neurotransmitter (full agonist). If a neurotransmitter is not present partial agonist display a functional antagonist activity. This is as a result of receptor binding reducing any response with the neurotransmitter.
Partial agonist in dopamine D2 receptors is an alternative option when treating schizophrenia. It acts as a functional antagonist mesolimbic dopamine pathway, and the excessive dopamine activity causes positive symptoms. However, reduced dopamine activity in the mesocortical pathway causes cognitive impairment and negative symptoms.
Elaborate on the receptor agonist-antagonist actions of the drugs and describe the most common side effects seen with these drugs.
Inhibition of dopamine function is the most common feature of antipsychotic drugs. D4 receptor activation in moderate levels helps antipsychotic agents protect the brain from negative and cognitive symptoms of schizophrenia. D2 and D3 receptors help improve positive symptoms of schizophrenia but are not successful in countering negative and cognitiv.
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
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.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. •Psychotic illnesses include various disorders, but the term antipsychotic drugs –
previously known as neuroleptic drugs, antischizophrenic drugs or major
tranquillizers.
•conventionally refers to those used to treat schizophrenia, one of the most
common and debilitating forms of mental illness.
•These same drugs are also used to treat mania and other acute behavioral
disturbances.
•Pharmacologically, most are dopamine receptor antagonists, although many of
them also act on other targets, particularly 5-hydroxytryptamine (5-HT)
receptors, which may contribute to their clinical efficacy.
•Existing drugs have many drawbacks in terms of their efficacy and side effects.
•Gradual improvements have been achieved with newer drugs, but radical new
approaches will require a better understanding of the causes and underlying
pathology of the disease, which are still poorly understood.
3. •THE NATURE OF SCHIZOPHRENIA
•Schizophrenia affects about 1% of the population.
•It is one of the most important forms of psychiatric illness, because it affects
young people, is often chronic and is usually highly disabling.
•There is a strong hereditary factor in its aetiology, and evidence suggestive of a
fundamental biological disorder.
•The main clinical features of the disease are as follows.
•Positive symptoms
•Delusions (often paranoid in nature).
•Hallucinations (often in the form of voices, which may be exhortatory in their
message).
•Thought disorder (comprising wild trains of thought, delusions of grandeur,
garbled sentences and irrational conclusions).
•Abnormal, disorganized behavior (such as stereotyped movements,
disorientation and occasionally aggressive behaviors).
•Catatonia (can be apparent as immobility or purposeless motor activity).
4. •Negative symptoms
•Withdrawal from social contacts.
•Flattening of emotional responses.
•Anhedonia (an inability to experience pleasure).
•Reluctance to perform everyday tasks.
•Cognition
•Deficits in cognitive function (e.g. attention, memory).
5. •In addition, anxiety, guilt, depression and self punishment are often present,
leading to suicide attempts in up to 50% of cases, about 10% of which are
successful.
•The clinical phenotype varies greatly, particularly with respect to the balance
between positive and negative symptoms, and this may have a bearing on the
efficacy of antipsychotic drugs in individual cases.
•Schizophrenia can present dramatically, usually in young people, with
predominantly positive features such as hallucinations, delusions and
uncontrollable behavior, or more insidiously in older patients with negative
features such as flat mood and social withdrawal.
•There is debate about whether cognitive impairment can develop even before
the onset of other symptoms.
6. •Schizophrenia can follow a relapsing and remitting course, or be chronic and
progressive, particularly in cases with a later onset.
•AETIOLOGY AND PATHOGENESIS OF SCHIZOPHRENIA
•GENETIC AND ENVIRONMENTAL FACTORS
•The causes of schizophrenia remain unclear but involve a combination of genetic
and environmental factors.
•Thus a person may have a genetic makeup that predisposes them to
schizophrenia, but exposure to environmental factors may be required for
schizophrenia to develop.
•The disease shows a strong, but incomplete, hereditary tendency.
•In first-degree relatives, the risk is about 10%, but even in monozygotic (identical)
twins, one of whom has schizophrenia, the probability of the other being
affected is only about 50%, pointing towards the importance of environmental
factors.
•Genetic linkage studies have identified more than 100 potential susceptibility
7. •There are significant associations between polymorphisms in individual genes
and the likelihood of an individual developing schizophrenia but there appears to
be no single gene that has an overriding influence.
•Some of the genes implicated in schizophrenia are also associated with bipolar
disorder.
•THE NEUROANATOMICAL AND NEUROCHEMICAL BASIS OF SCHIZOPHRENIA
•Different symptoms of schizophrenia appear to result from malfunctions in
different neuronal circuits.
•Changes in the mesolimbic pathway (the neuronal projection from the ventral
tegmental area (VTA) to the nucleus accumbens, amygdala and hippocampus)
being associated with positive symptoms, whereas negative symptoms are
associated with changes in the mesocortical pathway (the projection from the
VTA to areas of the prefrontal cortex).
•The main neurotransmitters thought to be involved in the pathogenesis of
schizophrenia are dopamine and glutamate.
8. •Dopamine
•The original dopamine theory of schizophrenia was proposed by Carlson –
awarded a Nobel Prize in 2000 – on the basis of indirect pharmacological
evidence in humans and experimental animals.
•Amphetamine releases dopamine in the brain and can produce in humans a
behavioral syndrome reminiscent of an acute schizophrenic episode.
•Also, hallucinations are a side effect of levodopa and dopamine agonists used for
Parkinson’s disease.
•In animals, dopamine release causes a specific pattern of stereotyped behavior
that resembles the repetitive behaviors sometimes seen in schizophrenic
patients.
•Potent D2-receptor agonists, such as bromocriptine, produce similar effects in
animals, and these drugs, like amphetamine, exacerbate the symptoms of
schizophrenic patients.
9. •Furthermore, dopamine antagonists and drugs that block neuronal dopamine
storage (e.g. reserpine) are effective in controlling the positive symptoms of
schizophrenia, and in preventing amphetamine-induced behavioral changes.
•Glutamate
•In humans, NMDA receptor antagonists such as phencyclidine, ketamine and
dizocilpine can produce positive, negative and cognitive deficit symptoms.
•In contrast to amphetamine, which produces only positive symptoms.
•In the brains from schizophrenic patients expression of the glutamate uptake
transporter VGLUT1 is reduced, which may indicate a disruption of glutamatergic
nerve terminals.
•It has therefore been postulated that schizophrenia may result from disruption of
glutamatergic neurotransmission, evident as a reduction in the function of NMDA
receptors (the NMDA hypofunction hypothesis).
•Consistent with this hypothesis, transgenic mice in which NMDA receptor
expression is reduced (not abolished, because this is fatal) show stereotypic
behaviors and reduced social interaction that are features of human
schizophrenia and that respond to antipsychotic drugs.
10. •Neurodegeneration
•Factors such as structural abnormalities in the brains of schizophrenics and
progression of the disease
•absence of symptoms in early childhood, the likelihood of positive symptoms
becoming apparent before negative symptoms, progressive worsening, reduced
responsiveness to drugs with time and the development of dementia are all
suggestive of ongoing neurodegeneration in the disease.
•The causes of such neurodegeneration are unclear at present but may involve
glutamate-induced excitotoxicity.
•The hope is that a fuller understanding of the altered function of glutamate
transmission in schizophrenia will lead to the development of new, improved
antipsychotic drugs.
11. •ANTIPSYCHOTIC DRUGS
•CLASSIFICATION OF ANTIPSYCHOTIC DRUGS
•Main categories are:
•first-generation (‘typical’, ‘classical’ or ‘conventional’) antipsychotics (e.g.
chlorpromazine, haloperidol, fluphenazine, flupentixol, clopentixol) –
•second-generation (‘atypical’) antipsychotics (e.g. clozapine, risperidone,
sertindole, quetiapine, amisulpride, aripiprazole, zotepine, ziprasidone).
•Distinction between first and second-generation drugs is not clearly defined but
rests on:
•receptor profile
•incidence of extrapyramidal side effects (less in second-generation group)
•efficacy (specifically of clozapine) in ‘treatment-resistant’ group of patients
• efficacy against negative symptoms.
12.
13.
14.
15.
16. •CLINICAL EFFICACY
•The clinical efficacy of antipsychotic drugs in enabling schizophrenic patients to
lead more normal lives has been demonstrated in many controlled trials.
•The inpatient population (mainly chronic schizophrenics) of mental hospitals
declined sharply in the 1950s and 1960s.
•The introduction of antipsychotic drugs was a significant enabling factor, as well
as the changing public and professional attitudes towards hospitalization of the
mentally ill.
•Antipsychotic drugs have severe drawbacks that include:
•Not all schizophrenic patients respond to drug therapy. It is recommended to try
clozapine in patients who are resistant to other antipsychotic drugs.
•The 30% of patients who do not respond are classed as ‘treatment resistant’ and
present a major therapeutic problem.
•The reason for the difference between responsive and unresponsive patients is
unknown at present, although there is some evidence (not conclusive) that
polymorphisms within the family of dopamine and 5-HT receptors may be
involved.
17. •While they control the positive symptoms (thought disorder, hallucinations,
delusions, etc.) effectively, most are ineffective in relieving the negative
•symptoms (emotional flattening, social isolation) and cognitive impairment.
•They induce a range of side effects that include extrapyramidal motor, endocrine
and sedative effects that can be severe and limit patient compliance.
•They may shorten survival through cardiac (pro-arrhythmic) effects.
•Second-generation antipsychotic drugs were believed to overcome these
shortcomings to some degree.
•However, a meta-analysis (concluded that only some of the second-generation
antipsychotic drugs examined, showed better overall efficacy.
•There is a definite need for the development of new treatments.
•Abrupt cessation of antipsychotic drug administration may lead to a rapid onset
psychotic episode distinct from the underlying illness.
18. •PHARMACOLOGICAL PROPERTIES
•DOPAMINE RECEPTORS
•There are five subtypes, which fall into two functional classes: the D1 type,
comprising D1 and D5, and the D2 type, comprising D2, D3 and D4.
•Antipsychotic drugs owe their therapeutic effects mainly to blockade of D2
receptors.
•As stated above, antipsychotic effects require about 80% block of D2 receptors.
•The first-generation compounds show some preference for D2 over D1 receptors,
•whereas some of the later agents (e.g. sulpiride, amisulpride, remoxipride) are
highly selective for D2 receptors.
• D2 antagonists that dissociate rapidly from the receptor (e.g. quetiapine) and D2
partial agonists (e.g. aripiprazole) have been introduced in an attempt to reduce
extrapyramidal motor side effects
19. •It is the antagonism of D2 receptors in the mesolimbic pathway that is believed
to relieve the positive symptoms of schizophrenia.
•Unfortunately, systemically administered antipsychotic drugs do not discriminate
between D2 receptors in distinct brain regions and D2 receptors in other brain
pathways will also be blocked.
•Thus, antipsychotic drugs produce unwanted motor effects (block of D2
receptors in the nigrostriatal pathway),
•enhance prolactin secretion, (block of D2 receptors in the tuberoinfundibular
pathway),
•reduce pleasure (block of D2 receptors in the reward component of the
mesolimbic pathway)
•and perhaps even worsen the negative symptoms of schizophrenia (block of D2
receptors in the prefrontal cortex, although these are only expressed at a low
density D1 receptors being in greater abundance).
20. •While all antipsychotic drugs block D2 receptors and should therefore in theory
induce all of these unwanted effects, some have additional pharmacological
activity (e.g. mACh receptor antagonism and 5-HT2A receptor antagonism) that,
to varying degrees, ameliorate unwanted effects.
•5-HT2A antagonism may also help to alleviate the negative and cognitive
impairments of schizophrenia.
•Antipsychotic drugs have classically been thought have a delayed onset to their
therapeutic actions, even though their dopamine receptor-blocking action is
immediate. This view has, however, been called into question.
•In animal studies, chronic antipsychotic drug administration does produce
compensatory changes in the brain, for example a reduction in the activity of
dopaminergic neurons and proliferation of dopamine receptors, detectable as an
increase in haloperidol binding, with a pharmacological super sensitivity to
dopamine reminiscent of the phenomenon of denervation super sensitivity.
21. • The mechanism(s) of these delayed effects are poorly understood.
• They are likely to contribute to the development of unwanted tardive dyskinesias.
• The sedating effect of antipsychotic drugs is immediate, allowing them to be used in
acute behavioral emergencies.
• 5-HYDROXYTRYPTAMINE RECEPTORS
• The idea that 5-HT dysfunction could be involved in schizophrenia has drifted in and out
of favor many times.
• It was originally based on the fact that LSD, a partial agonist at 5-HT2A receptors
produces hallucinations.
• Nowadays, conventional wisdom is that 5-HT is not directly involved in the
pathogenesis of schizophrenia.
• Nevertheless, pharmacological manipulation of 5-HT receptor activity, combined with
D2 receptor antagonism, has resulted in new drugs with improved therapeutic profiles.
• There is a plethora of 5-HT receptors, with disparate functions in the body.
• It is the 5-HT2A receptor and, to a lesser extent, the 5-HT1A receptor that are important
in the treatment of schizophrenia.
22. •5-HT2A receptors are Gi/Go-coupled receptors and their activation produces
neuronal inhibition (through decreased neuronal excitability at the soma and
decreased transmitter release at the nerve terminals; ).
•In this way, in the nigrostriatal pathway, 5-HT2A receptors control the release of
dopamine.
•Drugs with 5-HT2A antagonist properties (e.g. olanzapine and risperidone)
enhance dopamine release in the striatum by reducing the inhibitory effect of
5-HT.
•This will reduce extrapyramidal side effects (see below). In contrast, in the
mesolimbic pathway, the combined effects of D2 and 5-HT2A antagonism are
thought to counteract the increased dopamine function that gives rise to positive
symptoms of schizophrenia.
•Further, enhancing both dopamine and glutamate release in the mesocortical
circuit, 5-HT2A receptor antagonism may improve the negative symptoms of
schizophrenia (Stahl, 2008).
23. •5-HT1A receptors are somatodendritic auto receptors that inhibit 5-HT release.
•Antipsychotic drugs that are agonists or partial agonists at 5-HT1A receptors (e.g.
quetiapine) may work by decreasing 5-HT release thus enhancing dopamine
release in the striatum and prefrontal cortex.
•MUSCARINIC ACETYLCHOLINE RECEPTORS
•Some phenothiazine antipsychotic drugs (e.g. pericyazine) have been reported to
produce fewer extrapyramidal side effects than others, and this was thought to
correlate with their muscarinic antagonist actions.
•Also, some second-generation drugs possess muscarinic antagonist properties
(e.g. olanzapine).
•In the striatum, dopaminergic nerve terminals are thought to innervate
cholinergic interneurons that express inhibitory D2 receptors.
24. •It is suggested that there is normally a balance between D2 receptor activation
and muscarinic receptor activation.
•Blocking D2 receptors in the striatum with an antipsychotic agent will result in
enhanced acetylcholine release on to muscarinic receptors, thus producing
extrapyramidal side effects, which are counteracted if the D2 antagonist also has
muscarinic antagonist activity.
•Maintaining the dopamine/acetylcholine balance was also the rationale for the
use of the muscarinic antagonist benztropine to reduce extrapyramidal effects of
antipsychotic drugs.
•Muscarinic antagonist activity does, however, induce side effects such as
constipation, dry mouth and blurred vision.
25. •UNWANTED EFFECTS
•EXTRAPYRAMIDAL MOTOR DISTURBANCES
•Antipsychotic drugs produce two main kinds of motor disturbance in humans:
acute dystonia and tardive dyskinesias, collectively termed extrapyramidal side
effects.
•These all result directly or indirectly from D2 receptor blockade in the
nigrostriatal pathway.
•Extrapyramidal side effects constitute one of the main disadvantages of
first-generation antipsychotic drugs.
•Second-generation drugs were thought to have less tendency to produce
extrapyramidal side effects.
•However, a long-term study of olanzapine, risperidone, quetiapine and
ziprasidone concluded that they too can induce extrapyramidal side effects.
•Even aripiprazole, which is a D2 partial agonist, has been reported to produce
this unwanted effect.
26. •Acute dystonias
•are involuntary movements (restlessness, muscle spasms, protruding tongue,
fixed upward gaze, neck muscle spasm), often accompanied by symptoms of
Parkinson’s disease.
•They occur commonly in the first few weeks, often declining with time, and are
reversible on stopping drug treatment.
•The timing is consistent with block of the dopaminergic nigrostriatal pathway.
Concomitant block of muscarinic receptors and 5-HT2A receptors mitigates the
motor effects of dopamine receptor antagonists.
27. •ENDOCRINE EFFECTS
•Dopamine, released in the median eminence by neurons of the
tuberohypophyseal pathway acts physiologically via D2 receptors to inhibit
prolactin secretion.
•Blocking D2 receptors by antipsychotic drugs can therefore increase the plasma
prolactin concentration (Fig. 46.2), resulting in breast swelling, pain and lactation
(known as ‘galactorrhea’), which can occur in men as well as in women.
•the effect is maintained during chronic antipsychotic administration, without any
habituation.
•Other less pronounced endocrine changes have also been reported, including a
decrease of growth hormone secretion, but these, unlike the prolactin response,
are believed to be relatively unimportant clinically.
•Because of its D2 receptor partial agonist action aripiprazole, unlike other
antipsychotic drugs, reduces prolactin secretion.
28. • OTHER UNWANTED EFFECTS
• Most antipsychotic drugs block a variety of receptors, particularly acetylcholine
(muscarinic), histamine (H1), noradrenaline (α) and 5-HT receptors.
• This gives rise to a wide range of side effects.
• They can produce sexual dysfunction-decreased libido and decreased arousal as well as
erection and ejaculation difficulties in men – through block of dopamine, muscarinic
and α1 receptors.
• Drowsiness and sedation, which tend to decrease with continued use, occur with many
antipsychotic drugs.
• phenothiazine antipsychotics (e.g. chlorpromazine and methotrimeprazine) and
contributes to their sedative and antiemetic properties but not to their antipsychotic
action.
• While block of muscarinic receptors produces a variety of peripheral effects, including
blurring of vision and increased intraocular pressure, dry mouth and eyes, constipation
and urinary retention it may, however, also be beneficial in relation to extrapyramidal
side effects.
• Blocking α adrenoceptors causes orthostatic hypotension but does not seem to be
important for their antipsychotic action
29. •Weight gain is a common and troublesome side effect.
•Increased risk of diabetes and cardiovascular disease occurs with several
second-generation antipsychotic drugs.
•These effects are probably related to their antagonist actions at H1, 5-HT and
muscarinic receptors.
•Antipsychotic drugs can prolong the QT interval in the heart giving rise to
arrhythmia and risk of sudden death.
•Various idiosyncratic and hypersensitivity reactions can occur, the most
important being the following:
•Jaundice, which occurs with older phenothiazines such as chlorpromazine.
•The jaundice is usually mild, associated with elevated serum alkaline
phosphatase activity (an ‘obstructive’ pattern), and disappears quickly when the
drug is stopped or substituted by a chemically unrelated antipsychotic.
30. •Leukopenia and agranulocytosis
•are rare but potentially fatal, and occur in the first few weeks of treatment.
•The incidence of leukopenia (usually reversible) is less than 1 in 10 000 for most
antipsychotic drugs, but much higher (1–2%) with clozapine, whose use therefore
requires regular monitoring of blood cell counts.
•Provided the drug is stopped at the first sign of leukopenia or anaemia, the effect
is reversible.
•Olanzapine appears to be free of this disadvantage.
•Urticarial skin reactions are common but usually mild.
•Excessive sensitivity to ultraviolet light may also occur.
•Antipsychotic malignant syndrome is a rare but serious complication similar to
the malignant hyperthermia syndrome seen with certain.
•Muscle rigidity is accompanied by a rapid rise in body temperature and mental
confusion.
•It is usually reversible, but death from renal or cardiovascular failure occurs in
10–20% of cases.
31. •PHARMACOKINETIC ASPECTS
•Chlorpromazine, in common with other phenothiazines, is erratically absorbed
after oral administration.
•Figure 46.3 shows the wide range of variation of the peak plasma concentration
as a function of dosage in 14 patients.
•Among four patients treated at the high dosage level of 6–8 mg/kg, the variation
in peak plasma concentration was nearly 90-fold; two showed marked side
effects, one was well controlled and one showed no clinical response.
•The relationship between the plasma concentration and the clinical effect of
antipsychotic drugs is highly variable, and the dosage has to be adjusted on a
trial-and-error basis.
•This is made even more difficult by the fact that at least 40% of schizophrenic
patients fail to take drugs as prescribed.
•It is remarkably fortunate that the acute toxicity of antipsychotic drugs is slight,
given the unpredictability of the clinical response.
32. •The plasma half-life of most antipsychotic drugs is 15–30 h, clearance depending
entirely on hepatic transformation by a combination of oxidative and conjugative
reactions.
•Most antipsychotic drugs can be given orally or in urgent situations by
intramuscular injection.
•Slow-release (depot) preparations of many are available, in which the active drug
is esterified with heptanoic or decanoic acid and dissolved in oil.
•Given as an intramuscular injection, the drug acts for 2–4 weeks, but initially may
produce acute side effects.
•These preparations are widely used to minimize compliance problems.