This document discusses mood stabilizers used to treat bipolar disorder. It describes the symptoms of mania and depression in bipolar disorder. Lithium, valproic acid, carbamazepine, lamotrigine and various antipsychotics are described as first-line mood stabilizing agents. The mechanisms of action of these drugs involve inhibition of inositol monophosphatase and other enzymes, decreasing intracellular inositol levels. Novel targets for treating bipolar disorder discussed include inhibition of glycogen synthase kinase-3, protein kinase C, modulation of brain-derived neurotrophic factor, enhanced Bcl2 expression, effects on oxidative stress, and modulation of glutamatergic transmission.
Bipolar disorder is a mood disorder with alternate episodes of mania and depression. the symptoms includes hyperexcitability, mood changes, psychological and behavioural affect, weight gain or weight loss, sleep disturbances, fatigue etc. Mania is a state with periods of great excitement or euphoria, delusions, and over activity. The presentation includes points about mania and treatment strategies of mania
antipsychotics history, managment of psychosis,side effect of antipsychotics, mechanism of antipsychotics, atypical antipsychotics,2nd generation antipsychotics.
Bipolar disorder is a mood disorder with alternate episodes of mania and depression. the symptoms includes hyperexcitability, mood changes, psychological and behavioural affect, weight gain or weight loss, sleep disturbances, fatigue etc. Mania is a state with periods of great excitement or euphoria, delusions, and over activity. The presentation includes points about mania and treatment strategies of mania
antipsychotics history, managment of psychosis,side effect of antipsychotics, mechanism of antipsychotics, atypical antipsychotics,2nd generation antipsychotics.
Mood stabilizers is one of the treatment of bipolar disorder. however the effect require more than 2 weeks to action, thus need to adjuct with benzodiazepine for first 2 weeks. Not a choice for aggressive patient. The example of mood stabilizer are lithium, sodium valproate, carbamazepine and lamotrigine. it is suggestible to use mnemonic of "Lisa Very Commitment Lady"
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
Psychotherapeutic agents are a key component in the management of psychiatric disorders. Knowledge in this aspect of therapy goes a long way to help the health professional and the patient as well. However, care must be taken in administering these agents to pregnant women, and if possible stop, or consult your psychiatrist before taking these agents.
Choosing the right drug for your patient is the most satisfactory feeling a physician get.
This presentation gives you the pharmacological profile, pharmacokinetics, mechanism of action, indication, indication in special groups, side effect profile, drug interactions, and cost of use.
The medications include lithium, valproate, lamotrigine, Carbamazepine, oxcarbazepine, licarbazepine, and others
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
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
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.
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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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
2. BIPOLAR DISORDER
• Bipolar disorder – also known as manic-depressive illness
• In bipolar affective disorder, patients suffer episodes of mania,
hypomania and depression, classically with periods of normal
mood in between.
3. BIPOLAR
DISORDER
Symptoms of bipolar
disorder in the manic phase:
excitement
hyperactivity
impulsivity
disinhibition
aggression
diminished need for sleep
psychotic symptoms in
some patients
cognitive impairment
5. BIPOLAR DISORDER
• The cause of the mood swings:
preponderance of catecholamine-related activity
Drugs that increase this activity
exacerbate mania
Drugs that reduce activity of dopamine or norepinephrine
relieve mania
Acetylcholine or glutamate may also be involved
6. MOOD STABILIZER:
DEFINITION
• Any medication that is able to decrease vulnerability to
subsequent episodes of mania or depression; and not
exacerbate the current episode or maintenance phase of
treatment.
7.
8. MOOD STABILISING AGENTS
• Lithium
• Lithium carbonate:
• used for acute-phase illness
• for prevention of recurrent manic and depressive episodes
• Li+ is the only mood stabilizer with data on suicide reduction in
bipolar patients
• Anticonvulsants:
• Carbamazepine and Valproic acid:
• for the treatment of acute mania and for prevention of its
recurrence.
• Lamotrigine:
• for prevention of recurrence (maintenance)
9. MOOD STABILISING
AGENTS
• Antipsychotics:
• Aripiprazole, chlorpromazine, olanzapine, quetiapine,
risperidone, and ziprasidone:
• for treatment of the manic phase of bipolar disorder.
• Olanzapine plus fluoxetine in combination and quetiapine:
• for treatment of bipolar depression.
10. LITHIUM - MOA
• acts by suppressing the formation of second messengers
involved in neurotransmitter signal transduction.
• Lithium reduces the formation of inositol triphosphate (IP3)
by inhibiting myoinositol-1-phosphatase, an enzyme in the
inositol phosphate pathway.
• This enzyme participates in the regeneration of inositol and
the inositol phosphate precursors to IP3.
11. LITHIUM –
MOA
• Lithium inhibits inositol monophosphatase (IMPase) and other important
enzymes in the normal recycling of membrane phosphoinositides,
including conversion of IP2 (inositol diphosphate) to IP1 (inositol
monophosphate) and the conversion of IP1 to inositol
• valproate & carbamazepine also decrease intracellular inositol
concentrations
12. Li inhibits inositol monophosphatase (IMPase)
↓ free inositol
↓phosphatidylinositol-4,5-bisphosphate (PIP2)
[the membrane precursor of IP3 & DAG]
depletion of the second-messenger source PIP2
causes reduced release of IP3 and DAG
decreased activity of PIP2 dependent pathways
(which are markedly increased during manic episode)
Mood Stabilising action
MECHANISM OF ACTION
13. LITHIUM –
THERAPEUTIC USES
• Bipolar Disorder : Treatment of acute mania and the prevention
of recurrences of bipolar illness
Lithium has slow onset of action (5-7 days are required for clinical
effect)
antipsychotic drugs (chlorpromazine or haloperidol) with or without
potent benzodiazepines (lorazepam or clonazepam) is preferred.
After mania is controlled, the antipsychotic drug may be stopped
and lithium continued as maintenance therapy
Sodium valproate can provide rapid antimanic effects. Once
patients are stabilized and cooperative, Lithium can be
introduced for longer-term mood stabilization, or valproate may
be continued alone
14. LITHIUM –
THERAPEUTIC USES
Now a days valproate, aripiprazole,
olanzapine, quetiapine, risperidone, and
ziprasidone are preferred over lithium
Advantages of Sodium Valproate over
Lithium:
Rapid action
Wider therapeutic index
Better tolerability
15. VALPROIC ACID
• now a first line in treatment of acute mania (as valproate acts
faster than lithium)
• an alternative to antipsychotic ± benzodiazepine.
• effective in patients not responding to lithium or not
tolerating it
• mixed states and rapid cycling forms of bipolar disorder may
be more responsive to valproate than to lithium
16. VALNOCTAMIDE
• Valproic acid is widely used to treat BP; however, its
teratogenicity limits its use in women of childbearing
potential.
• Valnoctamide is an analogue of valproic acid, but it does not
undergo biotransformation to the corresponding free acid.
• It also lacks key structural groups (eg, free carboxylic groups)
implicated in valproic acid’s teratogenicity.
• In preclinical studies, valnoctamide was markedly less
teratogenic than valproic acid.
17. CARBAMAZEPINE
• may be used to treat acute mania and also for prophylactic
therapy
• may be used alone or, in refractory patients, in combination
with lithium
18. LAMOTRIGINE
• used in the maintenance therapy of bipolar disorder
• effective in reducing the frequency of recurrent depressive
cycles and in the treatment of bipolar depression
• not effective in treating acute mania
• Lamotrigine can be combined with lithium to improve its
efficacy
19. ATYPICAL
ANTIPSYCHOTICS
• Olanzapine, risperidone, aripiprazole, quetiapine, with or
without a BZD, are now the first line drugs for control of acute
mania
• for urgent parenteral therapy, but older neuroleptics are still
the most effective.
• Aripiprazole has emerged as the favoured drug for treatment
of mania in bipolar disorder
• used both as monotherapy as well as adjuvant to lithium or
valproate
• prevents mania, but not depressive episodes
• Lack of metabolic effects, favours its long-term use
20. ATYPICAL
ANTIPSYCHOTICS
• Olanzapine is also approved for maintenance therapy of
bipolar disorder.
• both manic and depressive phases are suppressed
• not considered suitable for long-term therapy due to higher
risk of weight gain, hyperglycaemia, etc.
• Quetiapine is effective in bipolar depression.
• Combination of an atypical antipsychotic with valproate or
lithium has demonstrated high efficacy in acute phases as well
as for maintenance therapy of bipolar disorder.
21. ANTIDEPRESSANTS
• Depression that persists after lithium therapy is started may
respond to antidepressant drugs.
• The use of antidepressants especially TCAs in patients who
have bipolar disorder and are not taking lithium or another
mood-stabilizing drug can precipitate a manic response in
many patients.
• (switch phenomenon)
23. GLYCOGEN SYNTHASE KINASE 3
(GSK-3) INHIBITION
• GSK-3 is a kinase involved in the regulation of cell apoptosis
and synaptic plasticity.
• Its inhibition influences gene transcription, with consequent
anti-apoptotic effect
• GSK-3 inhibition increases hippocampal levels of β-catenin, a
function implicated in mood stabilization
• Both Li+ and valproate treatment inhibit the activity of
glycogen synthase kinase-3β (GSK-3β)
24. PKC INHIBITION
• Excessive intracellular calcium influx results in increased apoptosis,
destruction of the cytoskeleton and intensification of the oxidative
stress.
• These disturbances in calcium mobilization are related in part to
hyperactivity of PKC, which has been demonstrated among
subjects with BD
• Therefore, drugs whose putative effects implicate PKC inhibition
may play a role in the treatment of BD
• Lithium and valproic acid inhibit PKC
• Tamoxifen, an estrogen antagonist (used in the treatment of
breast cancer) can cross BBB & has strong inhibitory effects on
PKC.
• Omega-3 fatty acids might represent a protective factor against
the development of BD
• Omega-3 Fatty acids act as antagonists of the PI-PKC signal
transduction pathway, ultimately inhibiting PKC activity
25. BRAIN-DERIVED NEUROTROPHIC
FACTOR (BDNF) MODULATION
• BDNF and other neurotrophic factors increase cell survival by
direct neurotrophic effect and apoptosis inhibition.
• There is evidence suggesting that chronic administration of
lithium and valproate may result in increased transcription of
those factors
26. ENHANCED BCL2 EXPRESSION
• Bcl2 is a protein with marked anti-apoptotic activity
• involved in neuronal protection and regeneration
• In rats, chronic administration of lithium and valproate is
associated with increased levels of Bcl2 in the prefrontal areas
• atypical antipsychotic olanzapine is associated with increased
expression of Bcl2 in the prefrontal cortex and hippocampus of
rodents
• Pramipexole is a dopamine agonist currently approved for
treatment of Parkinson’s disease and is associated with
increased expression of Bcl2 in the frontal cortex
27. EFFECTS ON OXIDATIVE STRESS
• increased oxidative stress contributes to cellular death in BD
patients.
• Lithium and olanzapine have demonstrated antioxidant
properties, which may be partially responsible for their
neuroprotective effects
28. MODULATION OF GLUTAMATERGIC
TRANSMISSION
• the effects of lithium on the glutamatergic system are
possibly related to its neuroprotective properties.
• Glutamate is the main excitatory neurotransmitter in the CNS
• involved in the regulation of several processes, including
neuronal and synaptic plasticity, memory consolidation and
information processing
• increases in the glutamatergic transmission in the CNS bring
about prolonged synaptic excitatory transmission, with
excitotoxicity and, ultimately, neuronal death.
• Lithium is believed to inhibit the calcium influx that results
from the stimulation of the NMDA glutamate receptors and
lamotrigine, a well-established mood stabilizer, blocks the
neuronal sodium channels, thus inhibiting the release of
glutamate
29. MODULATION OF GLUTAMATERGIC
TRANSMISSION
• drugs with demonstrated effect on the glutamatergic system
may be of particular interest in the management of the
depressive phase of BD.
• Memantine: low-affinity antagonist of the NMDA glutamate
receptor, currently FDA- approved for treatment of Alzheimer’s
disease.
• Amantadine: non- competitive antagonist of the NMDA
receptor currently approved for treatment of Parkinson’s
disease.
• Ketamine: an anesthetic, ketamine is a high-affinity NMDA
antagonist seems effective in the treatment of resistant
unipolar depression
• Riluzole: a potent glumatergic modulator, currently FDA-
approved for treatment of amiotrophic lateral sclerosis
30. RAMELTEON
• Ramelteon acts as a selective agonist of melatonin receptors
(MT1 & MT2) within the suprachiasmatic nucleus (SCN).
• Although approved to treat insomnia, Ramelteon is under
investigation as a treatment for bipolar disorder.
• It’s efficacy for bipolar maintenance and mania attenuation
may be because of its ability to regulate circadian rhythms.
• Regulation of circadian rhythms minimizes likelihood of
mood stability and prevents cycling to a manic and/or
depressive state.
32. SUMMARY –
NOVEL TARGETS FOR BD
• Inositol monophosphatase inhibition
• Glycogen synthase kinase 3 (GSK-3) inhibition
• Protein kinase C (PKC) inhibition
• Brain-derived neurotrophic factor (BDNF) modulation
• Enhanced Bcl2 expression
• Effects on oxidative stress
• Modulation of glutamatergic transmission
33. CONCLUSION
• During the last decade, significant progress in the knowledge
of BD has been achieved, mainly derived from the better
understanding of the molecular targets of mood stabilizing
drugs.
• These advances have led to identify a various novel targets
which will potentially result in improved therapeutics for BD
in the near future.