Advanced Psychopharmacology and Health Promotion

Unit 7 Discussion
Peer Response. Medications for Psychosis and Schizophrenia Related Disorders 600W. APA. 4 references due 10-20-23.

Instructions:

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

JS1

Which antipsychotics are considered first-generation, and why are they used less often than second-generation antipsychotics? Are second-generation antipsychotics more effective?

The first-generation antipsychotic (FGA) medications include chlorpromazine, fluphenazine, droperidol, loxapine, haloperidol, pimozide, perphenazine, thioridazine, prochlorperazine, thiothixene, and trifluoperazine. FGA drugs exert their therapeutic effects by antagonizing dopamine (D2) receptors, specifically addressing the positive symptoms associated with schizophrenia. According to Chokhawala & Stevens, 2023), first-generation antipsychotics are considerably more likely to elicit extrapyramidal movements (i.e., tardive dyskinesia) than second-generation and are thus used less commonly. Second-generation antipsychotic (SGA) medicines have antagonistic effects on the D2 receptor but are often called serotonin-dopamine antagonists. There is also some evidence to suggest that antipsychotics of the second generation provide better symptom management than those of the first generation (Chokhawala & Stevens, 2023). The efficacy of second-generation antipsychotics in addressing the negative symptoms of schizophrenia surpasses that of first-generation antipsychotics, while also demonstrating use in managing the positive symptoms of the disorder.

Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics.

Tardive dyskinesia (TD) is a collection of involuntary, repeated movements resulting from disrupting or blocking dopamine receptors. Involuntary motions may range from akathisia and dystonia to buccolingual stereotypy and myoclonus to chorea and tics (Paudel et al., 2023). There is currently no therapy available for TD. However, there are a variety of therapy methods available for reducing symptoms. While other drugs may also contribute to TD, conventional antipsychotics are the most common culprits. Paudel et al. (2023) provide a cautious estimate that around 5% of individuals experience TD annually when on conventional antipsychotics. Statistically speaking, older people have a far greater incidence rate.

Tardive dyskinesia, athetosis, acute dystonia, and tics are all instances of involuntary movements, as stated by Paudel et al. (2023). Repetitive muscular contractions, known as tics, often affect only one part of the body and are sometimes suppressed. Acute dystonia is characterized by sustained, repeated muscular contractions typically triggered by an intentional activity. Slow, writhing motions are characteristic of athetosis, often affecting the arms and hands.

References

Chokhawala, K., & Stevens, L. (2023). Antipsychotic medications. In StatPearls [Internet]. StatPearls Publishing. 
https://www.ncbi.nlm.nih.gov/books/NBK519503
Links to an external site.

Paudel, S., Donovan, A. L., Petriceks, A., Vyas, C. M., Van Alphen, M. U., & Stern, T. A. (2023). Drug-Induced Abnormal Involuntary Movements: Prevalence and Treatment. The Primary Care Companion for CNS Disorders, 25(3), 47041. 
https://www.psychiatrist.com/pcc/effects/drug-induced-abnormal-involuntary-movements-prevalence-and-treatment/
Links to an external site.

SY-2

Which antipsychotics are considered first-generation and why are they used less often than second-generation antipsychotics? Are second-generation antipsychotics more effective?

Both first-generation antipsychotics and second-generation antipsychotics are used for the treatment of psychiatric disorders such as schizophrenia. First-generation antipsychotics, also known as typical antipsychotics, such as phenothiazines (perphenazine, prochlorperazine), and butyrophenones (haloperidol) are classified by their chemical structure (Chokhawala, 2023). Whereas second-generation antipsychotics also known as atypical antipsychotics such as risperidone, olanzapine, quetiapine, aripiprazole, and clozapine are classified based on pharmacological proprieties (Chokhawala, 2023).

First-generation antipsychotics tend to be used less often than second-generation antipsychotics due to their long list of adverse effects that include extrapyramidal side effects, anticholinergic side effects (dry mouth, urinary retention, constipation), prolonged QT intervals, sedation, as well as the rare but fatal neuroleptic malignancy syndrome (Chokhawala, 2023). In comparison, second-generation antipsychotics have a decreased risk of extrapyramidal side effects but are associated with weight gain and metabolic syndrome, therefore patients should be monitored for diabetes, dyslipidemia, and weight gain (Chokhawala, 2023). Although second-generation antipsychotics tend to be the drug of choice when it comes to treating psychiatric disorders, and this is mainly due to the less severe side effects, this does not necessarily indicate that it is more effective. A study done by Fabrazzo et al. (2022) showed that second-generation antipsychotics showed no clear evidence of their effectiveness on cognitive deficit, however, it did prove to be more effective than first-generation antipsychotics in treating negative symptoms, relapse-free survival, and hospitalization rate.

                                                                                                                                  

Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics.

 Tardive Dyskinesia 
(TD) is a disorder characterized by repetitive movement such as facial and tongue movement, tongue protrusion, facial grimacing, chewing, and quick, jerking limb movements. These movements are involuntary and can range in severity (slight tremor to full body movement) thus, making daily function difficult. Its main cause is long-term use of antipsychotics, and this disorder tends to be irreversible (Bergman & Soares-Weiser, 2018).

Acute Dystonia is a neurological symptom characterized by muscle contractions that cause repetitive movements by arms, legs, neck, face, or abnormal posture (Stahl, 2022). The cause of this reaction is due to a dopaminergic-cholinergic imbalance in the basal ganglia (Lewis, 2023). Early intervention can prevent the onset and development of dystonia and neurological damage and treatments include benzodiazepines, baclofen, muscle relaxants, and dopamine depletes (VMAT-2 inhibitors) (Bledsoe et al., 2020).

Akathisia and Tics syndromes are seen in patients treated with D2 blockers and are characterized by inner restlessness and mental unease (Stahl, 2022). Akathisia is a neuropsychiatric syndrome characterized by the inability to remain still and it typically involves the lower extremity (Patel, 2023). Tics on the other hand such as Tourette syndrome are neurodevelopmental disorders characterized by motions, noise, and words and are involuntary (Jones, 2023).

  

References

Bergman, H., & Soares-Weiser, K. (2018). Anticholinergic medication for antipsychotic-induced tardive dyskinesia. 
Cochrane Database of Systematic Reviews, 
2018(1). https://doi.org/10.1002/14651858.cd000204.pub2

Bledsoe, I. O., Viser, A. C., & San Luciano, M. (2020). Treatment of dystonia: Medications, neurotoxins, neuromodulation, and rehabilitation. 
Neurotherapeutics, 
17(4), 1622–1644. https://doi.org/10.1007/s13311-020-00944-0

 Chokhawala, K. (2023, February 26). 
Antipsychotic medications. StatPearls – NCBI Bookshelf. 
https://www.ncbi.nlm.nih.gov/books/NBK519503/Links to an external site.

Fabrazzo, M., Cipolla, S., Camerlengo, A., Perris, F., & Catapano, F. (2022). Second-Generation Antipsychotics’ Effectiveness and Tolerability: A Review of Real-World Studies in Patients with Schizophrenia and Related Disorders. 
Journal of Clinical Medicine, 
11(15), 4530. https://doi.org/10.3390/jcm11154530

Jones, K. S. (2023, May 8). 
Tourette syndrome and other TIC disorders. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK499958/

Lewis, K. (2023, May 1). 
Dystonic reactions. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK531466/#:~:text=An%20acute%20dystonic%20reaction%20is,to%20abnormal%20movements%20or%20postures.

Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).

Patel, J. (2023, July 24). 
Akathisia. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK519543/#:~:text=Akathisia%20is%20defined%20as%20an,usually%20involves%20the%20lower%20extremities.

Math 225: week 1

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Week 1: Evidence Claims and Study Types

Week 1: Variables and Measures of Data

Week 1: Sampling Methods

Week 1: Comparing Sampling Methods

 Screening is the administration of measures or tests to distinguish individuals who may have a condition from those who probably do not have it.  Discuss the advantages and disadvantages of screening.   

Week 4 ion channel —2 Peer Response 800w. due9-26-23

Instructions:

Please read and respond to the two peers' initial postings for week 2 below. Consider the following questions in your responses.

Compare and contrast your initial posting with those of your peers.  

1. How are they similar or how are they different?

2. What information can you add that would help support the responses of your peers?

3. Ask your peers a question for clarification about their post.

4. What most interests you about their responses? 

5. Summaries at least 1 evidence based article that supports there point.

Please be sure to validate your opinions and ideas with citations and references in APA format.

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Response 1 400 words mam

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Differentiate between the opening of a ligand-gated ion channel and a voltage-sensitive ion channel.

·         In the nervous system, there are two important types of ion channels: voltage-gated ion channels and ligand-gated ion channels. Both of these ion channels play crucial roles in transmitting electrical signals, often referred to as messages, throughout the nervous system. Each type of channel has its own specific mechanism for opening and closing. These ion channel proteins are influenced by various stimuli or external factors, which can trigger their activation or deactivation within the cell's plasma membrane (Xiao-Yu, 2023). 

·         Ligand-gated ion channels, as their name suggests, require a ligand to open. Ligands are chemical messengers that can bind to protein receptors on the channel. In simpler terms, when a specific chemical, such as a neurotransmitter, binds to the channel's receptor, it triggers a conformational change in the protein channel. As a result, the channel gains the ability to open, allowing ions (usually Na+, K+, or Cl-) to flow through the channel pore (Stahl, 2021). Ligands can include neurotransmitters, hormones, medications, and other molecules. Each ligand-gated ion channel has a specific binding site for its particular ligand. Most ligand-gated ion channels are located at synapses. When neurotransmitters are released into the synaptic cleft, they can bind to their specific binding sites on ligand-gated ion channels found in the post-synaptic cell membrane. This binding facilitates the transfer of signals. Ligand-gated channels are known for their rapid response and are well-suited for fast synaptic transmissions (Stahl, 2021).

·         Voltage-gated ion channels are distinct from ligand-gated channels in that they respond to changes in electrical charge, specifically the membrane potential, rather than chemical ligands. These ion channels are regulated by alterations in the voltage across the cell membrane. The distribution of positive and negative ions on either side of the cell membrane varies. Typically, during the resting state, the inside of the cell membrane carries a more negative charge compared to the outside. When a signal is potent enough to elevate the positive voltage within the cell membrane, reaching a critical threshold, the voltage-gated channels open (depolarization). During the depolarization period, voltage-gated ion channels allow the transfer of ions, which initiates an action potential. Various stimuli or external factors have the capability to trigger the activation or deactivation of voltage-gated channel proteins present within the cell's plasma membrane. Voltage-sensitive channels are distributed along the axons and dendrites of neurons throughout the nervous system. Additionally, they can be found in other excitable cell types, including muscle and cardiac cells (Stahl, 2021).

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References

· Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).

· Xiao-Yu, D. (2023). Calcium ion channels in Saccharomyces cerevisiae.
 Journal of Fungi, 9(5), 524. https://doi.org/10.3390/jof9050524

Response 2. 400 words mc

Compare and contrast the two different major classes of ion channels.

The two major classes of ion channels according to Stahl (2021), are 
ligand-gated ion channels, ionotropic receptors and ion-channel-linked receptors and 
voltage-sensitive or voltage-gated ion channels. Ligand-gated ion channels are ion channels that are closed and opened by actions of neurotransmitter ligands at receptors acting as gatekeepers. The neurotransmitter binds to the gatekeeper receptor, which in turn causes a conformational change in the receptor, opening the ion channel. The receptors regulate the opening and closing of the ion channels and are therefore ligand-gated ion channels. On the other hand, the opening and closing of voltage-sensitive or voltage-gated ion channels is regulated by voltage potential or ionic charge across the membrane in which they reside (Stahl, 2021).

Explain the difference between full agonists, partial agonists, antagonists, inverse agonists.

The action of full agonists is to change the conformation of the receptor to open the ion channel the maximum amount and frequency allowed by the binding site (Stahl, 2021). Consequently, the maximum amount of downside signal transduction is triggered and medicated by the binding site. In contrast, partial agonists change the receptor conformation to open the ion channel to a greater extent and more frequently than its resting state (Stahl, 2021). As a result, the downstream signal transduction and ion flow produced in the absence of an agonist is greater than the resting state but less than that of full agonists.

Antagonists, on the other hand, stabilize the receptor in the resting state, which is similar to the state of the receptor in the absence of agonist (Stahl, 2021). Antagonists are said to be silent or neutral because the resting state is the same in the absence or presence of an antagonist. The resting state of an antagonist is not a fully closed ion channel and as a result, some degree of ion flow through the channel even in the absence of an agonist and in the presence of antagonist. Inverse agonists are neither neutral nor silent like the antagonists. They produce a conformational change in the receptors at ligand-gated ion channels causing the channel to close first, then stabilizing it in an inactive form. As a result of inactive conformation action of inverse agonists, ion flow and signal transduction are functionally reduced compared to the resting state. The action of inverse agonists is reversed by antagonists (Stahl, 2021).

References

Stahl, S. M. (2021). 
Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.

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