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Tardive Dyskinesia Risk Factors: One of These Should Jump Off the Page · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back,
• 0:06
  my
• 0:06
  friends,
• 0:06
  to
• 0:06
  another
• 0:06
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:08
  Prep.
• 0:08
  Npz.
• 0:09
  Here,
• 0:09
  your
• 0:09
  preceptor
• 0:10
  in
• 0:10
  your
• 0:10
  pocket,
• 0:11
  your
• 0:11
  go
• 0:11
  to
• 0:11
  place
• 0:12
  for
• 0:12
  pearls
• 0:12
  that
• 0:13
  prep
• 0:13
  you
• 0:13
  to
• 0:13
  practice.
• 0:14
  Well,
• 0:14
  back
• 0:15
  by
• 0:15
  popular
• 0:15
  demand,
• 0:16
  we
• 0:17
  have
• 0:17
  a
• 0:17
  board
• 0:18
  bomb
• 0:18
  for
• 0:18
  you,
• 0:19
  my
• 0:19
  friends.
• 0:20
  This
• 0:20
  one
• 0:21
  is
• 0:21
  going
• 0:21
  to
• 0:22
  challenge
• 0:22
  us
• 0:22
  to
• 0:23
  assess
• 0:23
  risk,
• 0:24
  particularly
• 0:25
  risk
• 0:25
  as
• 0:26
  it
• 0:26
  relates
• 0:26
  to
• 0:26
  tardive
• 0:27
  dyskinesia.
• 0:28
  And
• 0:28
  for
• 0:28
  those
• 0:29
  of
• 0:29
  you
• 0:29
  that
• 0:29
  study
• 0:30
  ancient
• 0:30
  Greek,
• 0:31
  you
• 0:31
  might
• 0:32
  have
• 0:32
  an
• 0:32
  idea
• 0:33
  that
• 0:33
  tardive
• 0:34
  dyskinesia
• 0:34
  means
• 0:35
  late
• 0:36
  abnormal
• 0:37
  movements.
• 0:37
  That's
• 0:37
  right.
• 0:37
  The
• 0:38
  tardive
• 0:39
  part
• 0:39
  of
• 0:39
  that
• 0:40
  is
• 0:40
  kind
• 0:40
  of
• 0:40
  like
• 0:40
  when
• 0:41
  your
• 0:41
  friends
• 0:41
  say,
• 0:41
  hey,
• 0:42
  you're
• 0:42
  tardy,
• 0:43
  you're
• 0:43
  late.
• 0:44
  Why
• 0:44
  are
• 0:44
  you
• 0:44
  so
• 0:44
  tardy?
• 0:46
  We've
• 0:46
  been.
• 0:46
  We
• 0:47
  already
• 0:47
  ordered
• 0:47
  the
• 0:47
  appetizer.
• 0:49
  The
• 0:49
  ceviche's
• 0:50
  here.
• 0:51
  What
• 0:51
  are
• 0:51
  you
• 0:52
  doing?
• 0:52
  You
• 0:52
  were
• 0:52
  supposed
• 0:52
  to
• 0:53
  be
• 0:53
  here
• 0:53
  an
• 0:53
  hour
• 0:53
  ago.
• 0:55
  Tardive
• 0:56
  late
• 0:57
  dis
• 0:59
  D
• 0:59
  Y
• 0:59
  S
• 1:00
  Ancient
• 1:01
  Greek,
• 1:01
  I
• 1:01
  believe,
• 1:02
  meaning
• 1:03
  abnormal.
• 1:04
  Like
• 1:04
  you
• 1:04
  just
• 1:04
  got
• 1:05
  dissed
• 1:06
  or
• 1:06
  this
• 1:06
  is.
• 1:06
  This
• 1:07
  family
• 1:07
  is
• 1:07
  dysfunctional.
• 1:10
  I
• 1:10
  am
• 1:10
  dissatisfied
• 1:11
  with
• 1:12
  you.
• 1:13
  Okay?
• 1:14
  Dis
• 1:15
  is
• 1:15
  bad.
• 1:15
  Usually
• 1:17
  rappers,
• 1:18
  they
• 1:18
  release
• 1:18
  diss
• 1:19
  tracks.
• 1:21
  Eminem,
• 1:21
  Moby.
• 1:22
  You
• 1:22
  remember
• 1:22
  those
• 1:23
  days?
• 1:24
  Can't
• 1:24
  even
• 1:24
  say
• 1:24
  what
• 1:24
  he
• 1:25
  said
• 1:25
  about
• 1:25
  Moby
• 1:25
  back
• 1:26
  then.
• 1:27
  Okay,
• 1:28
  and
• 1:28
  then
• 1:28
  kinesia
• 1:29
  is
• 1:29
  movement,
• 1:30
  right?
• 1:30
  Kinetics,
• 1:31
  kinesia.
• 1:32
  Now,
• 1:32
  this
• 1:32
  is
• 1:32
  not
• 1:32
  a
• 1:32
  language
• 1:33
  episode,
• 1:34
  but
• 1:34
  I
• 1:34
  do
• 1:35
  like
• 1:35
  to
• 1:36
  make
• 1:36
  things
• 1:37
  so
• 1:38
  that
• 1:38
  you
• 1:38
  don't
• 1:39
  forget
• 1:39
  them.
• 1:40
  So
• 1:41
  tardive
• 1:41
  dyskinesia,
• 1:42
  I
• 1:43
  want
• 1:43
  you
• 1:43
  to
• 1:43
  think
• 1:43
  of
• 1:43
  that
• 1:44
  ceviche
• 1:44
  platter,
• 1:46
  your
• 1:46
  friend
• 1:47
  who
• 1:47
  thought
• 1:47
  he
• 1:48
  was
• 1:48
  better
• 1:48
  than
• 1:48
  you
• 1:48
  and
• 1:48
  got
• 1:49
  to
• 1:49
  dinner
• 1:50
  late.
• 1:51
  I
• 1:51
  want
• 1:51
  you
• 1:51
  to
• 1:51
  think
• 1:52
  of
• 1:52
  the
• 1:52
  Eminem
• 1:52
  dis
• 1:53
  track.
• 1:54
  And
• 1:55
  then
• 1:55
  I
• 1:55
  want
• 1:55
  you
• 1:55
  to
• 1:55
  think
• 1:55
  of
• 1:56
  kinesia
• 1:56
  or
• 1:57
  movement.
• 1:57
  So
• 1:57
  there's
• 1:58
  no
• 1:58
  mnemonic
• 1:59
  at
• 1:59
  all
• 1:59
  there
• 1:59
  at
• 1:59
  all.
• 1:59
  So.
• 2:00
  But
• 2:01
  anyway,
• 2:02
  so
• 2:02
  tardive
• 2:03
  dyskinesia,
• 2:04
  it's
• 2:04
  a
• 2:04
  major
• 2:05
  problem.
• 2:05
  It's
• 2:05
  very
• 2:06
  stigmatizing.
• 2:06
  People
• 2:07
  have
• 2:07
  a
• 2:07
  very
• 2:07
  hard
• 2:07
  time
• 2:08
  speaking.
• 2:09
  They're
• 2:10
  afraid
• 2:10
  to
• 2:10
  go
• 2:10
  out
• 2:10
  in
• 2:11
  public
• 2:11
  because
• 2:13
  the
• 2:13
  movements
• 2:14
  can
• 2:14
  be
• 2:14
  very.
• 2:16
  I
• 2:16
  don't
• 2:16
  want
• 2:16
  to
• 2:16
  use
• 2:17
  the
• 2:17
  word
• 2:17
  outrageous,
• 2:17
  but
• 2:18
  they.
• 2:18
  They
• 2:18
  can
• 2:18
  be
• 2:19
  just
• 2:19
  very
• 2:21
  blatant,
• 2:22
  right?
• 2:22
  Lip
• 2:23
  smacking
• 2:23
  and
• 2:24
  blinking
• 2:24
  excessively
• 2:25
  and
• 2:27
  kind
• 2:27
  of
• 2:27
  slithering
• 2:28
  around
• 2:29
  in
• 2:29
  your
• 2:29
  chair.
• 2:30
  Those
• 2:30
  trunk.
• 2:31
  Your
• 2:31
  trunk
• 2:31
  is
• 2:32
  just
• 2:32
  kind
• 2:32
  of
• 2:32
  wildly
• 2:32
  gyrating.
• 2:33
  So
• 2:34
  these
• 2:34
  are.
• 2:34
  These
• 2:34
  are
• 2:34
  very
• 2:35
  disabling
• 2:35
  movements.
• 2:36
  And
• 2:37
  we
• 2:37
  have
• 2:37
  to
• 2:37
  be
• 2:38
  very
• 2:38
  strong
• 2:39
  guardians
• 2:40
  and
• 2:40
  advocates
• 2:41
  for
• 2:41
  our
• 2:41
  patients
• 2:41
  because
• 2:42
  this
• 2:42
  is
• 2:42
  no
• 2:42
  picnic.
• 2:43
  And
• 2:43
  so
• 2:43
  your
• 2:44
  challenge
• 2:44
  today
• 2:44
  with
• 2:44
  this
• 2:45
  bork
• 2:45
  bomb
• 2:46
  is,
• 2:46
  let's
• 2:47
  say
• 2:47
  you
• 2:47
  have
• 2:47
  a
• 2:47
  slot
• 2:48
  open
• 2:48
  tomorrow.
• 2:49
  You
• 2:49
  can
• 2:49
  only
• 2:49
  see
• 2:50
  one
• 2:50
  patient
• 2:50
  in
• 2:51
  that
• 2:51
  slot
• 2:51
  that
• 2:51
  opened
• 2:52
  up
• 2:52
  and
• 2:52
  you
• 2:52
  want
• 2:52
  to
• 2:52
  do
• 2:53
  a
• 2:53
  tardive
• 2:54
  dyskinesia
• 2:55
  deep
• 2:56
  dive.
• 2:56
  You
• 2:56
  want
• 2:56
  to
• 2:57
  assess
• 2:57
  which
• 2:58
  of
• 2:58
  these
• 2:58
  five
• 2:58
  patients
• 2:59
  is
• 3:00
  most
• 3:00
  at
• 3:00
  risk
• 3:00
  for
• 3:01
  td
• 3:02
  and
• 3:02
  you're
• 3:02
  going
• 3:02
  to
• 3:03
  do
• 3:03
  an
• 3:03
  Ames
• 3:03
  assessment
• 3:04
  on
• 3:04
  them.
• 3:05
  That's
• 3:05
  the
• 3:05
  Abnormal
• 3:07
  Involuntary
• 3:07
  movement
• 3:08
  scale,
• 3:09
  the
• 3:09
  12
• 3:10
  item
• 3:10
  assessment
• 3:11
  tool
• 3:11
  that
• 3:12
  you
• 3:12
  use
• 3:12
  to
• 3:12
  determine
• 3:13
  the
• 3:13
  severity
• 3:13
  of
• 3:14
  tardive
• 3:14
  dyskinesia
• 3:15
  and
• 3:15
  those
• 3:15
  movements.
• 3:16
  So
• 3:16
  you
• 3:16
  get
• 3:16
  one
• 3:16
  of
• 3:17
  these
• 3:17
  five
• 3:17
  patients
• 3:18
  only
• 3:18
  you
• 3:18
  got
• 3:19
  to
• 3:19
  pick
• 3:19
  the
• 3:19
  highest
• 3:19
  risk
• 3:20
  and
• 3:20
  they're
• 3:20
  going
• 3:20
  to
• 3:20
  come
• 3:20
  in
• 3:21
  for
• 3:21
  30
• 3:21
  or
• 3:21
  60
• 3:22
  minutes
• 3:22
  for
• 3:22
  you
• 3:22
  to
• 3:23
  do
• 3:23
  an
• 3:23
  AIMS
• 3:24
  assessment
• 3:24
  on
• 3:24
  them.
• 3:25
  So
• 3:25
  my
• 3:25
  question
• 3:25
  to
• 3:26
  you,
• 3:26
  my
• 3:26
  friends
• 3:27
  is
• 3:27
  which
• 3:27
  one
• 3:27
  of
• 3:27
  these
• 3:28
  five
• 3:28
  patients
• 3:29
  are
• 3:29
  you
• 3:29
  going
• 3:29
  to
• 3:29
  pick
• 3:29
  as
• 3:30
  the
• 3:30
  highest
• 3:30
  risk
• 3:30
  that
• 3:31
  you
• 3:31
  need
• 3:31
  to
• 3:31
  see
• 3:31
  tomorrow?
• 3:33
  Okay.
• 3:33
  And
• 3:33
  this
• 3:34
  little
• 3:34
  thought
• 3:34
  exercise,
• 3:35
  this
• 3:35
  little
• 3:35
  board
• 3:35
  bomb.
• 3:36
  So
• 3:36
  are
• 3:37
  you
• 3:37
  going
• 3:37
  to
• 3:37
  see
• 3:37
  patient
• 3:38
  A,
• 3:38
  a
• 3:38
  28
• 3:39
  year
• 3:39
  old
• 3:39
  male
• 3:39
  with
• 3:40
  schizophrenia
• 3:40
  who
• 3:40
  was
• 3:41
  started
• 3:41
  on
• 3:41
  Risperidol
• 3:42
  4mg
• 3:42
  3
• 3:43
  months
• 3:43
  ago?
• 3:44
  Are
• 3:45
  you
• 3:45
  going
• 3:45
  to
• 3:45
  see
• 3:45
  patient
• 3:46
  B,
• 3:46
  a
• 3:47
  72
• 3:47
  year
• 3:47
  old
• 3:47
  female
• 3:48
  with
• 3:48
  major
• 3:49
  depressive
• 3:49
  disorder
• 3:50
  on
• 3:50
  low
• 3:50
  dose
• 3:50
  Abilify
• 3:51
  for
• 3:51
  six
• 3:52
  months
• 3:52
  as
• 3:52
  adjunctive
• 3:53
  therapy?
• 3:54
  Are
• 3:54
  you
• 3:54
  going
• 3:54
  to
• 3:55
  see
• 3:55
  Patient
• 3:56
  C,
• 3:56
  a
• 3:56
  35
• 3:57
  year
• 3:57
  old
• 3:57
  female
• 3:58
  with
• 3:58
  bipolar
• 3:59
  1,
• 3:59
  on
• 3:59
  Seroquel
• 4:00
  600
• 4:01
  a
• 4:01
  day
• 4:01
  for
• 4:02
  two
• 4:02
  years?
• 4:03
  Are
• 4:03
  you
• 4:03
  going
• 4:03
  to
• 4:03
  see
• 4:04
  patient
• 4:04
  D,
• 4:05
  a
• 4:05
  45
• 4:06
  year
• 4:06
  old
• 4:06
  male
• 4:06
  with
• 4:06
  schizophrenia,
• 4:07
  recently
• 4:08
  switched
• 4:08
  from
• 4:09
  Haldol
• 4:09
  to
• 4:10
  Clozapine
• 4:11
  after
• 4:11
  10
• 4:12
  years
• 4:13
  of
• 4:13
  Haldol
• 4:14
  use,
• 4:14
  that's
• 4:15
  a
• 4:15
  first
• 4:15
  generation
• 4:15
  antipsychotic.
• 4:17
  Or
• 4:17
  are
• 4:17
  you
• 4:17
  going
• 4:18
  to
• 4:18
  see
• 4:18
  patient
• 4:18
  E,
• 4:19
  a
• 4:19
  32
• 4:20
  year
• 4:20
  old
• 4:20
  male
• 4:20
  with
• 4:21
  schizophrenia
• 4:22
  on
• 4:22
  Zyprexa
• 4:22
  20
• 4:23
  milligrams
• 4:23
  a
• 4:23
  day
• 4:24
  for
• 4:24
  five
• 4:24
  years?
• 4:25
  Okay,
• 4:26
  you
• 4:26
  can
• 4:27
  pause
• 4:27
  this,
• 4:27
  you
• 4:27
  can
• 4:27
  get
• 4:28
  into
• 4:28
  your
• 4:28
  breakout
• 4:29
  groups,
• 4:29
  discuss
• 4:30
  with
• 4:30
  your
• 4:30
  peers,
• 4:31
  your
• 4:31
  professors.
• 4:33
  So
• 4:34
  my
• 4:34
  friends,
• 4:35
  what
• 4:36
  this
• 4:36
  question
• 4:37
  is
• 4:37
  trying
• 4:37
  to
• 4:37
  tease
• 4:38
  out
• 4:38
  specifically
• 4:39
  is
• 4:39
  very
• 4:39
  simple.
• 4:41
  Do
• 4:41
  you
• 4:41
  understand
• 4:42
  what
• 4:42
  the
• 4:43
  highest
• 4:43
  risk
• 4:44
  factor
• 4:45
  is
• 4:45
  in
• 4:45
  developing
• 4:46
  tardive
• 4:46
  dyskinesia?
• 4:47
  Plain
• 4:48
  and
• 4:48
  simple.
• 4:49
  Right?
• 4:49
  And
• 4:49
  you
• 4:50
  have
• 4:50
  a
• 4:50
  lot
• 4:50
  of
• 4:50
  variables
• 4:51
  here
• 4:51
  that
• 4:51
  were
• 4:51
  shared
• 4:52
  with
• 4:52
  you
• 4:52
  throughout
• 4:53
  these
• 4:53
  questions.
• 4:54
  No
• 4:54
  need
• 4:54
  to
• 4:54
  memorize
• 4:54
  them.
• 4:55
  I
• 4:55
  know
• 4:55
  I
• 4:55
  just
• 4:55
  kind
• 4:55
  of
• 4:55
  gave
• 4:56
  you
• 4:56
  a
• 4:56
  mouthful
• 4:56
  of
• 4:56
  choices.
• 4:58
  But
• 4:58
  you
• 4:58
  have
• 4:59
  the
• 4:59
  patient's
• 4:59
  ages,
• 5:00
  you
• 5:00
  have
• 5:00
  the
• 5:00
  patient's
• 5:01
  genders,
• 5:01
  you
• 5:02
  have
• 5:02
  the
• 5:02
  patient's
• 5:02
  diagnosis,
• 5:03
  whether
• 5:03
  it's
• 5:04
  schizophrenia
• 5:04
  or
• 5:05
  major
• 5:05
  depressive
• 5:05
  disorder.
• 5:06
  You
• 5:06
  have
• 5:06
  the
• 5:06
  dose
• 5:07
  of
• 5:07
  the
• 5:07
  medications
• 5:08
  they're
• 5:08
  on,
• 5:08
  you
• 5:08
  have
• 5:08
  the
• 5:08
  medications
• 5:09
  that
• 5:09
  are
• 5:09
  on,
• 5:09
  you
• 5:10
  have
• 5:10
  the
• 5:10
  duration
• 5:11
  of
• 5:11
  the
• 5:11
  medications
• 5:12
  they're
• 5:12
  on.
• 5:12
  So
• 5:13
  somewhere
• 5:13
  in
• 5:13
  that
• 5:14
  question
• 5:14
  it's
• 5:15
  trying
• 5:15
  to
• 5:15
  tease
• 5:15
  out
• 5:16
  do
• 5:16
  you
• 5:16
  know
• 5:16
  the
• 5:16
  single
• 5:17
  greatest
• 5:17
  risk
• 5:17
  factor?
• 5:18
  And
• 5:18
  the
• 5:18
  good
• 5:18
  news
• 5:19
  is
• 5:19
  if
• 5:19
  you
• 5:19
  do
• 5:19
  know
• 5:20
  what
• 5:20
  that
• 5:20
  is,
• 5:21
  you
• 5:21
  don't
• 5:21
  really
• 5:21
  have
• 5:21
  to
• 5:21
  go
• 5:22
  into
• 5:22
  the
• 5:22
  weeds
• 5:23
  with
• 5:23
  respect
• 5:23
  to
• 5:24
  what
• 5:24
  are
• 5:24
  all
• 5:24
  these
• 5:24
  meds,
• 5:25
  what
• 5:25
  do
• 5:25
  they
• 5:25
  do.
• 5:26
  What
• 5:26
  are
• 5:26
  their
• 5:26
  D2
• 5:26
  affinities?
• 5:28
  You
• 5:28
  don't
• 5:28
  have
• 5:28
  to
• 5:28
  even
• 5:29
  know
• 5:29
  that,
• 5:29
  because
• 5:29
  the
• 5:30
  answer
• 5:30
  is
• 5:30
  actually
• 5:31
  shockingly
• 5:32
  fast
• 5:32
  and
• 5:32
  simple.
• 5:32
  If
• 5:33
  you
• 5:33
  know
• 5:33
  that
• 5:33
  risk
• 5:34
  factor.
• 5:34
  Okay,
• 5:35
  and
• 5:35
  I'll
• 5:35
  just
• 5:35
  go
• 5:35
  ahead
• 5:35
  and
• 5:36
  tell
• 5:36
  it
• 5:36
  to
• 5:36
  you,
• 5:36
  and
• 5:37
  we
• 5:37
  can
• 5:37
  go
• 5:37
  into
• 5:37
  the
• 5:38
  details
• 5:38
  here,
• 5:39
  but
• 5:39
  the
• 5:39
  single
• 5:40
  greatest
• 5:40
  risk
• 5:41
  factor
• 5:41
  for
• 5:41
  developing
• 5:42
  TD
• 5:43
  is
• 5:43
  not
• 5:43
  the
• 5:44
  kind
• 5:44
  of
• 5:44
  antipsychotic
• 5:45
  you're
• 5:45
  on.
• 5:45
  Although
• 5:46
  that
• 5:46
  is
• 5:46
  relevant.
• 5:47
  Um,
• 5:48
  it's
• 5:48
  not
• 5:48
  the
• 5:49
  dose,
• 5:49
  although
• 5:50
  that
• 5:50
  is
• 5:50
  also
• 5:50
  relevant.
• 5:52
  Right.
• 5:52
  It
• 5:53
  is
• 5:53
  actually
• 5:54
  your
• 5:55
  age.
• 5:56
  Your
• 5:56
  age
• 5:56
  is
• 5:57
  the
• 5:57
  single
• 5:57
  greatest
• 5:58
  risk
• 5:58
  factor.
• 5:59
  And
• 6:00
  in
• 6:00
  this
• 6:00
  case,
• 6:00
  my
• 6:01
  friends,
• 6:02
  we
• 6:02
  have
• 6:02
  a
• 6:02
  72
• 6:03
  year
• 6:03
  old
• 6:03
  in
• 6:03
  the
• 6:04
  question,
• 6:04
  and
• 6:04
  this
• 6:04
  was
• 6:04
  a
• 6:05
  very
• 6:05
  confusing
• 6:05
  one
• 6:05
  for
• 6:06
  many
• 6:06
  people
• 6:06
  because
• 6:07
  she's
• 6:08
  being
• 6:08
  medicated
• 6:08
  for
• 6:08
  major
• 6:09
  depressive
• 6:09
  disorder.
• 6:10
  And
• 6:10
  we
• 6:10
  don't
• 6:10
  always
• 6:10
  think
• 6:11
  of
• 6:11
  tardive
• 6:12
  dyskinesia
• 6:13
  as
• 6:13
  a
• 6:15
  major
• 6:15
  depressive
• 6:16
  disorder
• 6:16
  problem.
• 6:17
  But
• 6:17
  this
• 6:18
  is
• 6:18
  why
• 6:18
  we
• 6:18
  have
• 6:18
  to
• 6:18
  look
• 6:19
  at
• 6:19
  all
• 6:19
  of
• 6:19
  our
• 6:19
  medications
• 6:21
  very
• 6:21
  objectively
• 6:22
  and
• 6:23
  to
• 6:23
  get
• 6:23
  out
• 6:23
  of
• 6:24
  the
• 6:24
  labels
• 6:25
  and
• 6:25
  understand
• 6:26
  what
• 6:26
  they're
• 6:26
  doing.
• 6:27
  Right.
• 6:27
  It's
• 6:27
  not
• 6:27
  enough
• 6:27
  to
• 6:28
  just
• 6:28
  say,
• 6:28
  oh,
• 6:28
  this
• 6:28
  is
• 6:28
  a
• 6:29
  depression
• 6:29
  adjunct.
• 6:30
  So
• 6:30
  it's
• 6:30
  an
• 6:30
  antidepressant.
• 6:31
  Well,
• 6:31
  not
• 6:32
  quite.
• 6:32
  Abilify
• 6:33
  still
• 6:34
  blocks
• 6:34
  dopamine
• 6:35
  receptors.
• 6:36
  It's
• 6:36
  a
• 6:37
  partial
• 6:37
  agonist.
• 6:37
  So
• 6:37
  when
• 6:38
  dopamine
• 6:38
  is
• 6:39
  excessive,
• 6:39
  it
• 6:40
  will
• 6:40
  attenuate
• 6:41
  dopamine.
• 6:41
  When
• 6:42
  dopamine
• 6:42
  is
• 6:42
  deficient
• 6:43
  in
• 6:43
  certain
• 6:43
  parts
• 6:43
  of
• 6:43
  the
• 6:43
  brain,
• 6:44
  it
• 6:44
  will
• 6:45
  increase
• 6:45
  the
• 6:46
  dopamine
• 6:47
  tone
• 6:47
  in
• 6:47
  those
• 6:47
  parts
• 6:48
  of
• 6:48
  the
• 6:48
  brain.
• 6:48
  Right.
• 6:49
  That's
• 6:49
  why
• 6:49
  the
• 6:49
  mesocortical
• 6:50
  areas,
• 6:50
  you'll
• 6:50
  have
• 6:51
  improved
• 6:51
  cognition.
• 6:52
  But
• 6:52
  at
• 6:53
  higher
• 6:53
  doses,
• 6:54
  Abilify
• 6:55
  can
• 6:55
  actually
• 6:56
  mitigate
• 6:57
  psychotic
• 6:57
  symptoms
• 6:58
  in
• 6:58
  the
• 6:58
  mesolimbic
• 6:59
  circuits.
• 7:00
  So
• 7:00
  it
• 7:01
  can
• 7:01
  very
• 7:01
  well
• 7:02
  still
• 7:02
  be
• 7:02
  problematic.
• 7:03
  And
• 7:04
  especially
• 7:04
  if
• 7:04
  Your
• 7:04
  patient
• 7:05
  is
• 7:05
  72
• 7:05
  years
• 7:06
  old.
• 7:06
  72
• 7:07
  years
• 7:07
  old.
• 7:08
  Age
• 7:08
  is
• 7:08
  the
• 7:08
  single
• 7:09
  greatest
• 7:09
  risk
• 7:09
  factor
• 7:11
  when
• 7:11
  it
• 7:11
  comes
• 7:11
  to
• 7:11
  developing
• 7:12
  td,
• 7:13
  and
• 7:13
  the
• 7:14
  fact
• 7:14
  that
• 7:14
  she's
• 7:14
  a
• 7:14
  female
• 7:15
  also
• 7:15
  compounds
• 7:16
  that.
• 7:16
  Postmenopausal
• 7:17
  females
• 7:19
  are
• 7:19
  also
• 7:19
  implicated
• 7:20
  in
• 7:20
  increased
• 7:21
  risk.
• 7:22
  And
• 7:22
  shockingly,
• 7:23
  the
• 7:23
  risk
• 7:24
  factors
• 7:24
  for
• 7:25
  older
• 7:25
  folks
• 7:26
  is
• 7:26
  like
• 7:27
  a
• 7:27
  new
• 7:27
  incidence
• 7:27
  of
• 7:28
  25
• 7:28
  to
• 7:28
  30%
• 7:29
  per
• 7:29
  year
• 7:30
  compared
• 7:30
  to
• 7:30
  4
• 7:31
  to
• 7:31
  5%
• 7:31
  in
• 7:32
  younger
• 7:32
  adults.
• 7:32
  To
• 7:32
  me,
• 7:33
  that's
• 7:33
  a
• 7:33
  very
• 7:33
  shocking
• 7:34
  pearl
• 7:34
  drop.
• 7:35
  That's
• 7:35
  a
• 7:35
  very
• 7:35
  big
• 7:36
  deal.
• 7:36
  Um,
• 7:37
  and
• 7:38
  quite
• 7:38
  frankly,
• 7:39
  it's
• 7:39
  a
• 7:39
  little
• 7:40
  alarming
• 7:41
  because
• 7:42
  even
• 7:42
  4
• 7:42
  to
• 7:43
  5%
• 7:43
  a
• 7:43
  year
• 7:44
  in
• 7:44
  younger
• 7:44
  adults
• 7:44
  is
• 7:45
  pretty
• 7:45
  scary,
• 7:45
  because
• 7:46
  after
• 7:46
  10
• 7:46
  years,
• 7:46
  what?
• 7:47
  You
• 7:47
  have
• 7:47
  about
• 7:47
  50%
• 7:48
  of
• 7:48
  them
• 7:48
  developing
• 7:49
  tardive
• 7:49
  dyskinesia,
• 7:50
  if
• 7:50
  you
• 7:50
  do
• 7:50
  the
• 7:50
  math.
• 7:51
  So
• 7:51
  what
• 7:51
  is
• 7:51
  it
• 7:52
  gonna
• 7:52
  take
• 7:52
  for
• 7:52
  older
• 7:53
  folks?
• 7:53
  Three
• 7:53
  years?
• 7:54
  Um,
• 7:54
  it's
• 7:54
  a
• 7:55
  big
• 7:55
  problem.
• 7:56
  And
• 7:56
  so
• 7:57
  age
• 7:57
  is
• 7:57
  what
• 7:57
  they're
• 7:58
  trying
• 7:58
  to
• 7:58
  sniff
• 7:58
  out
• 7:58
  here.
• 7:59
  It
• 7:59
  certainly
• 8:00
  helps
• 8:00
  you
• 8:00
  on
• 8:00
  the
• 8:01
  side
• 8:01
  if
• 8:01
  you
• 8:01
  also
• 8:02
  have
• 8:02
  an
• 8:02
  appreciation
• 8:03
  for,
• 8:03
  for
• 8:03
  which
• 8:04
  kinds
• 8:05
  of
• 8:05
  medications
• 8:06
  are
• 8:07
  worse
• 8:07
  offenders
• 8:08
  as
• 8:08
  it
• 8:08
  relates
• 8:08
  to
• 8:09
  TD
• 8:10
  and
• 8:10
  at
• 8:11
  what
• 8:11
  doses.
• 8:12
  So
• 8:12
  I
• 8:12
  know
• 8:12
  if
• 8:12
  you're
• 8:13
  a
• 8:13
  new
• 8:13
  grad
• 8:13
  or
• 8:13
  if
• 8:14
  you're,
• 8:14
  you
• 8:14
  know,
• 8:14
  developing
• 8:15
  your
• 8:15
  chops
• 8:16
  in
• 8:16
  psychiatry,
• 8:17
  it
• 8:17
  may
• 8:17
  not
• 8:17
  be
• 8:18
  immediately
• 8:18
  intuitive
• 8:19
  what
• 8:19
  these
• 8:19
  doses
• 8:20
  are.
• 8:20
  I
• 8:20
  highly
• 8:20
  recommend
• 8:21
  you
• 8:21
  get
• 8:21
  really
• 8:21
  familiar
• 8:22
  just
• 8:22
  with
• 8:24
  kind
• 8:24
  of
• 8:24
  Mama
• 8:25
  Bear,
• 8:25
  Papa
• 8:26
  Bear,
• 8:26
  Baby
• 8:26
  Bear
• 8:26
  dosing
• 8:27
  it
• 8:27
  dosing
• 8:28
  ranges.
• 8:28
  Right.
• 8:29
  You
• 8:29
  should
• 8:29
  have
• 8:29
  an
• 8:29
  idea
• 8:30
  whether
• 8:30
  Seroquel
• 8:31
  600
• 8:32
  is
• 8:32
  a
• 8:32
  high
• 8:33
  dose
• 8:33
  of
• 8:33
  Seroquel
• 8:34
  or
• 8:34
  not,
• 8:34
  or
• 8:35
  if
• 8:35
  Olanzapine
• 8:36
  20
• 8:36
  is
• 8:36
  a
• 8:37
  high
• 8:37
  dose
• 8:37
  or
• 8:38
  not.
• 8:39
  That's
• 8:39
  very
• 8:39
  helpful
• 8:40
  to
• 8:40
  a
• 8:40
  lot
• 8:40
  of
• 8:41
  people.
• 8:41
  Does
• 8:41
  take
• 8:42
  some
• 8:42
  getting
• 8:42
  used
• 8:42
  to.
• 8:42
  It
• 8:43
  will
• 8:43
  click.
• 8:43
  But
• 8:44
  just
• 8:44
  familiarize
• 8:44
  yourself
• 8:45
  with
• 8:45
  that.
• 8:45
  So
• 8:46
  you
• 8:46
  have
• 8:46
  an
• 8:46
  idea.
• 8:48
  But
• 8:49
  this
• 8:49
  was
• 8:49
  a
• 8:49
  bit
• 8:49
  of
• 8:49
  a
• 8:50
  trick
• 8:50
  question
• 8:50
  in
• 8:50
  a
• 8:51
  way.
• 8:51
  I
• 8:51
  didn't
• 8:51
  mean
• 8:51
  it
• 8:51
  to
• 8:51
  be,
• 8:52
  but
• 8:52
  you
• 8:53
  have
• 8:53
  someone
• 8:53
  who's
• 8:54
  on
• 8:54
  an
• 8:54
  adjunct
• 8:55
  for
• 8:55
  MDD
• 8:55
  and
• 8:56
  sure
• 8:56
  enough,
• 8:56
  because
• 8:56
  of
• 8:57
  their
• 8:57
  age,
• 8:58
  you
• 8:58
  have
• 8:58
  to
• 8:58
  really
• 8:58
  watch
• 8:59
  out
• 8:59
  for
• 9:00
  those
• 9:00
  tardive
• 9:00
  dyskinesia
• 9:01
  symptoms.
• 9:02
  Okay.
• 9:03
  Some
• 9:03
  of
• 9:03
  these
• 9:03
  answers
• 9:04
  aren't
• 9:04
  very
• 9:04
  bad
• 9:05
  either,
• 9:06
  to
• 9:06
  be
• 9:06
  quite
• 9:07
  honest
• 9:07
  with
• 9:07
  you.
• 9:08
  I
• 9:08
  think
• 9:09
  the
• 9:09
  one
• 9:09
  that
• 9:09
  caught
• 9:09
  my
• 9:10
  eye
• 9:10
  was
• 9:10
  a
• 9:10
  32
• 9:10
  year
• 9:11
  old
• 9:11
  male
• 9:11
  with
• 9:11
  schizophrenia
• 9:12
  on
• 9:12
  Zyprexa
• 9:13
  of
• 9:13
  20
• 9:13
  milligrams
• 9:14
  a
• 9:14
  day
• 9:14
  for
• 9:14
  five
• 9:14
  years.
• 9:15
  That
• 9:15
  risk
• 9:16
  is
• 9:16
  real.
• 9:16
  You
• 9:17
  know,
• 9:17
  we
• 9:17
  certainly
• 9:18
  saw
• 9:18
  more
• 9:18
  of
• 9:18
  a
• 9:19
  risk
• 9:19
  with
• 9:19
  like
• 9:20
  Haloperidol.
• 9:21
  Those
• 9:21
  first
• 9:21
  generation
• 9:22
  antipsychotics
• 9:22
  have
• 9:23
  carry
• 9:23
  a
• 9:23
  much
• 9:23
  higher
• 9:23
  risk
• 9:24
  of
• 9:24
  this.
• 9:25
  But
• 9:25
  there's
• 9:25
  an
• 9:26
  absolutely
• 9:26
  real
• 9:27
  risk
• 9:27
  with
• 9:27
  all
• 9:28
  antipsychotics
• 9:28
  period,
• 9:29
  including
• 9:29
  Zyprexa.
• 9:30
  It's
• 9:30
  a
• 9:30
  very
• 9:31
  potent
• 9:31
  D2
• 9:32
  blocker
• 9:32
  and
• 9:33
  20mg
• 9:34
  is
• 9:34
  not
• 9:35
  a
• 9:35
  baby
• 9:35
  bear
• 9:36
  dose
• 9:36
  for
• 9:36
  five
• 9:37
  years
• 9:37
  also
• 9:38
  is
• 9:38
  pretty
• 9:39
  significant.
• 9:40
  So
• 9:40
  a
• 9:41
  higher
• 9:42
  risk
• 9:42
  I
• 9:42
  think
• 9:43
  than
• 9:43
  some
• 9:43
  of
• 9:43
  those
• 9:43
  other
• 9:43
  patients.
• 9:44
  Not
• 9:44
  the
• 9:44
  72
• 9:45
  year
• 9:45
  old
• 9:45
  though.
• 9:47
  But
• 9:47
  I
• 9:47
  would,
• 9:48
  but
• 9:48
  I
• 9:48
  would
• 9:48
  still
• 9:48
  kind
• 9:49
  of
• 9:49
  watch
• 9:49
  that
• 9:49
  patient
• 9:50
  also.
• 9:51
  Now
• 9:51
  the
• 9:52
  45
• 9:52
  year
• 9:52
  old
• 9:53
  patient
• 9:53
  with
• 9:53
  schizophrenia
• 9:54
  recently
• 9:55
  switched
• 9:55
  from
• 9:56
  Haldol
• 9:56
  to
• 9:56
  Clozapine.
• 9:57
  That
• 9:57
  should
• 9:57
  help
• 9:58
  you
• 9:58
  a
• 9:58
  lot.
• 9:58
  That's
• 9:58
  kind
• 9:59
  of
• 9:59
  a
• 9:59
  no
• 9:59
  brainer
• 10:00
  if
• 10:00
  you
• 10:00
  just
• 10:01
  do
• 10:01
  a
• 10:01
  little
• 10:01
  bit
• 10:01
  of
• 10:02
  studying
• 10:02
  to
• 10:03
  know
• 10:03
  that
• 10:03
  Clozapine
• 10:04
  has
• 10:04
  a
• 10:04
  very
• 10:05
  favorable,
• 10:06
  it
• 10:06
  has
• 10:06
  the
• 10:06
  lowest
• 10:06
  TD
• 10:07
  risk
• 10:07
  of
• 10:07
  all
• 10:07
  antipsychotics
• 10:08
  and
• 10:08
  it
• 10:08
  might
• 10:09
  even
• 10:09
  actually
• 10:09
  improve
• 10:09
  existing
• 10:10
  TD
• 10:10
  symptoms.
• 10:11
  Okay,
• 10:12
  so
• 10:13
  that
• 10:13
  is
• 10:13
  not
• 10:13
  the
• 10:13
  answer.
• 10:14
  Clozapine
• 10:15
  is,
• 10:15
  is
• 10:16
  a
• 10:16
  lot
• 10:16
  safer
• 10:17
  when
• 10:17
  it
• 10:17
  comes
• 10:18
  to
• 10:18
  these
• 10:18
  categories.
• 10:19
  So
• 10:19
  is
• 10:19
  Quetiapine
• 10:20
  in
• 10:20
  option
• 10:21
  C,
• 10:21
  the
• 10:21
  35
• 10:22
  year
• 10:22
  old?
• 10:22
  Yes,
• 10:22
  she's
• 10:22
  at
• 10:22
  a
• 10:23
  high
• 10:23
  dose.
• 10:23
  Yes,
• 10:23
  she's
• 10:23
  been
• 10:24
  on
• 10:24
  it
• 10:24
  for
• 10:24
  two
• 10:24
  years.
• 10:25
  But
• 10:26
  Quetiapine
• 10:28
  has
• 10:28
  this
• 10:28
  kind
• 10:29
  of
• 10:30
  on
• 10:30
  and
• 10:30
  off
• 10:30
  pharmacokinetics,
• 10:31
  where
• 10:31
  it
• 10:32
  doesn't
• 10:32
  bind
• 10:32
  as
• 10:32
  tightly
• 10:33
  to
• 10:33
  D2,
• 10:33
  it
• 10:33
  kind
• 10:33
  of
• 10:34
  binds
• 10:34
  and
• 10:34
  then
• 10:34
  lets
• 10:34
  go.
• 10:34
  Binds
• 10:35
  and
• 10:35
  then
• 10:35
  lets
• 10:35
  go.
• 10:36
  And
• 10:36
  so
• 10:36
  by
• 10:36
  doing
• 10:37
  that,
• 10:37
  it
• 10:38
  kind
• 10:38
  of
• 10:38
  mitigates
• 10:39
  the
• 10:39
  risk
• 10:40
  that
• 10:40
  it's
• 10:40
  not
• 10:40
  as
• 10:41
  an.
• 10:41
  Tight.
• 10:41
  It's
• 10:42
  not
• 10:42
  as.
• 10:42
  It
• 10:43
  doesn't
• 10:43
  have
• 10:43
  as
• 10:43
  tight
• 10:43
  of
• 10:44
  a
• 10:44
  grip,
• 10:44
  this
• 10:45
  iron
• 10:45
  grip
• 10:45
  on
• 10:45
  the
• 10:45
  D2
• 10:46
  receptor
• 10:46
  that
• 10:47
  some
• 10:47
  of
• 10:47
  these
• 10:47
  other
• 10:47
  medications
• 10:48
  do.
• 10:48
  So
• 10:49
  I
• 10:49
  would
• 10:49
  lump
• 10:49
  quetiapine
• 10:50
  in
• 10:50
  the
• 10:50
  category
• 10:51
  of
• 10:52
  meds
• 10:52
  that
• 10:52
  you
• 10:52
  may
• 10:53
  want
• 10:53
  to
• 10:53
  look
• 10:53
  at.
• 10:53
  If
• 10:54
  your
• 10:54
  patient
• 10:55
  is
• 10:55
  in
• 10:56
  dire
• 10:56
  need
• 10:56
  of
• 10:57
  a
• 10:57
  switch
• 10:57
  because
• 10:57
  of
• 10:58
  td,
• 10:58
  of
• 10:58
  course,
• 10:58
  you
• 10:58
  have
• 10:59
  to
• 10:59
  do
• 10:59
  that
• 10:59
  very
• 10:59
  carefully.
• 11:00
  There's
• 11:00
  a
• 11:00
  lot
• 11:00
  of
• 11:02
  ramifications
• 11:03
  and
• 11:03
  potential
• 11:04
  consequences
• 11:04
  to
• 11:05
  that
• 11:05
  that
• 11:05
  we'll
• 11:05
  get
• 11:05
  into
• 11:05
  in
• 11:06
  a.
• 11:06
  In
• 11:06
  an
• 11:07
  episode
• 11:07
  in
• 11:07
  the
• 11:08
  next
• 11:08
  week
• 11:08
  or
• 11:08
  so.
• 11:09
  However,
• 11:10
  just
• 11:10
  know
• 11:10
  quetiapine
• 11:11
  is
• 11:11
  a
• 11:11
  little
• 11:11
  more.
• 11:12
  Also
• 11:12
  known
• 11:12
  as
• 11:12
  Seroquel,
• 11:13
  is
• 11:13
  a
• 11:13
  little
• 11:13
  more
• 11:14
  favorable
• 11:15
  in
• 11:15
  this
• 11:15
  sense.
• 11:16
  Risperidone
• 11:17
  option.
• 11:17
  A
• 11:18
  Risperidone
• 11:19
  is
• 11:19
  no
• 11:19
  picnic.
• 11:19
  It's
• 11:19
  a
• 11:19
  pretty
• 11:20
  potent
• 11:20
  D2
• 11:20
  blocker.
• 11:22
  It's.
• 11:23
  I
• 11:23
  would
• 11:23
  definitely
• 11:24
  watch
• 11:24
  that
• 11:24
  patient,
• 11:25
  but
• 11:25
  they've
• 11:26
  only
• 11:26
  been
• 11:26
  on
• 11:27
  risperidol
• 11:28
  for
• 11:28
  about
• 11:28
  three
• 11:29
  months.
• 11:29
  Definitely
• 11:30
  possible,
• 11:31
  but
• 11:32
  as
• 11:32
  we
• 11:32
  know,
• 11:32
  Tardive
• 11:33
  dyskinesia
• 11:34
  is
• 11:35
  a
• 11:35
  little
• 11:35
  bit
• 11:36
  of
• 11:36
  a
• 11:37
  slower
• 11:37
  burn,
• 11:39
  not
• 11:39
  to
• 11:39
  say
• 11:39
  that
• 11:39
  it's
• 11:40
  impossible.
• 11:40
  You
• 11:40
  got
• 11:41
  to
• 11:41
  screen
• 11:41
  your
• 11:41
  patients
• 11:42
  at
• 11:42
  all
• 11:42
  times
• 11:42
  for
• 11:42
  this.
• 11:43
  Some
• 11:43
  guidelines
• 11:44
  say
• 11:44
  every
• 11:44
  visit.
• 11:45
  Some
• 11:45
  guidelines
• 11:45
  that
• 11:46
  are
• 11:46
  more
• 11:46
  liberal
• 11:46
  will
• 11:46
  say
• 11:47
  every
• 11:47
  six
• 11:47
  months
• 11:47
  or
• 11:48
  every
• 11:48
  12
• 11:48
  months,
• 11:48
  depending
• 11:49
  on
• 11:49
  risk.
• 11:49
  Again,
• 11:50
  we're
• 11:50
  going
• 11:50
  to
• 11:50
  go
• 11:50
  into
• 11:50
  that
• 11:51
  much
• 11:51
  more
• 11:52
  specifically
• 11:52
  to
• 11:52
  empower
• 11:53
  you
• 11:53
  to
• 11:54
  get
• 11:54
  this
• 11:54
  done
• 11:54
  and
• 11:55
  figure
• 11:55
  it
• 11:55
  out
• 11:55
  early
• 11:56
  and
• 11:56
  proactively
• 11:56
  because
• 11:57
  there's
• 11:57
  really
• 11:57
  no
• 11:57
  excuse
• 11:58
  for
• 11:58
  any
• 11:58
  of
• 11:58
  us
• 11:59
  to
• 11:59
  allow
• 11:59
  this
• 11:59
  to
• 12:00
  happen.
• 12:00
  We
• 12:00
  should
• 12:01
  identify
• 12:01
  who's
• 12:01
  at
• 12:02
  high
• 12:02
  risk
• 12:02
  and
• 12:02
  even
• 12:03
  the
• 12:03
  ones
• 12:03
  who
• 12:03
  aren't
• 12:03
  high
• 12:03
  risk.
• 12:04
  We
• 12:04
  should
• 12:04
  regularly
• 12:05
  screen
• 12:05
  these
• 12:05
  folks
• 12:06
  using
• 12:07
  the
• 12:07
  AIM
• 12:07
  scale.
• 12:08
  It's
• 12:08
  very
• 12:08
  simple
• 12:09
  scale.
• 12:09
  It's
• 12:09
  a
• 12:10
  very.
• 12:10
  It's
• 12:10
  actually
• 12:10
  very
• 12:11
  visual.
• 12:11
  It's
• 12:11
  very
• 12:11
  simple
• 12:12
  to
• 12:12
  conduct
• 12:12
  in
• 12:13
  session.
• 12:14
  It's
• 12:15
  not.
• 12:15
  It's
• 12:15
  not
• 12:15
  super
• 12:15
  intricate,
• 12:16
  and
• 12:16
  it
• 12:16
  doesn't
• 12:17
  take
• 12:17
  a
• 12:17
  lot
• 12:17
  of
• 12:17
  time,
• 12:18
  and
• 12:18
  it'll
• 12:18
  definitely
• 12:19
  help,
• 12:20
  you
• 12:21
  know,
• 12:23
  curb
• 12:23
  these
• 12:23
  symptoms
• 12:24
  or
• 12:24
  prevent
• 12:24
  them
• 12:24
  entirely.
• 12:25
  This
• 12:25
  is
• 12:25
  definitely
• 12:26
  a
• 12:26
  case
• 12:26
  where
• 12:26
  an
• 12:27
  ounce
• 12:27
  of
• 12:27
  prevention
• 12:28
  is
• 12:28
  worth
• 12:29
  a
• 12:29
  pound
• 12:30
  of
• 12:31
  work,
• 12:32
  if
• 12:32
  you
• 12:32
  will.
• 12:33
  I
• 12:33
  think
• 12:33
  I
• 12:33
  butchered
• 12:34
  that
• 12:34
  idiom.
• 12:35
  An
• 12:36
  ounce
• 12:36
  of
• 12:36
  prevention
• 12:37
  is
• 12:37
  worth
• 12:37
  a
• 12:37
  pound
• 12:38
  of.
• 12:38
  Someone's
• 12:38
  gonna
• 12:39
  have
• 12:39
  to
• 12:39
  help
• 12:39
  me.
• 12:39
  I
• 12:39
  can't
• 12:40
  remember
• 12:40
  the
• 12:40
  rest
• 12:40
  of
• 12:40
  that,
• 12:41
  but
• 12:41
  it's
• 12:42
  really
• 12:42
  important.
• 12:42
  So,
• 12:44
  yeah,
• 12:44
  this
• 12:44
  was
• 12:44
  a
• 12:45
  fun
• 12:45
  one.
• 12:45
  I
• 12:46
  think
• 12:46
  it's
• 12:46
  really
• 12:46
  important
• 12:46
  for
• 12:47
  you
• 12:47
  to
• 12:48
  familiarize
• 12:48
  yourself
• 12:49
  with
• 12:49
  the
• 12:50
  affinity
• 12:52
  for
• 12:52
  all
• 12:52
  of
• 12:52
  these
• 12:53
  medications
• 12:55
  for
• 12:55
  the
• 12:55
  dopamine
• 12:56
  blockade
• 12:56
  in
• 12:56
  particular.
• 12:58
  And
• 12:58
  that
• 12:59
  way
• 12:59
  you're
• 12:59
  empowered
• 13:00
  in
• 13:00
  session.
• 13:00
  You
• 13:01
  don't
• 13:01
  get
• 13:01
  stuck
• 13:01
  when
• 13:01
  your
• 13:01
  patient
• 13:02
  is
• 13:02
  lip
• 13:02
  smacking
• 13:03
  or
• 13:03
  blinking
• 13:03
  excessively
• 13:05
  or
• 13:05
  kind
• 13:05
  of
• 13:05
  gyrating
• 13:06
  in
• 13:06
  their
• 13:06
  chair.
• 13:08
  You
• 13:08
  can,
• 13:09
  you
• 13:09
  can,
• 13:09
  you
• 13:09
  know,
• 13:09
  these
• 13:10
  hyperkinetic
• 13:10
  movements.
• 13:11
  You
• 13:11
  can
• 13:12
  ask
• 13:12
  yourself,
• 13:12
  well,
• 13:12
  what
• 13:13
  would
• 13:13
  be
• 13:14
  a
• 13:14
  more
• 13:15
  serviceable
• 13:15
  plan
• 13:16
  here?
• 13:17
  You
• 13:17
  know,
• 13:17
  you
• 13:17
  can
• 13:17
  add
• 13:17
  a
• 13:17
  VMAT2
• 13:18
  inhibitor.
• 13:19
  We
• 13:19
  can
• 13:19
  talk
• 13:19
  about
• 13:19
  that
• 13:20
  later.
• 13:20
  You
• 13:20
  can
• 13:21
  lower
• 13:21
  the
• 13:21
  dose
• 13:21
  in
• 13:22
  only
• 13:22
  if
• 13:22
  it's
• 13:23
  effective
• 13:23
  enough.
• 13:23
  You
• 13:24
  can't,
• 13:24
  you
• 13:24
  do
• 13:24
  not
• 13:24
  want
• 13:24
  to
• 13:25
  sacrifice
• 13:25
  therapeutic
• 13:26
  efficacy.
• 13:26
  You
• 13:26
  don't
• 13:26
  want
• 13:27
  to
• 13:27
  just
• 13:27
  lower
• 13:27
  the
• 13:27
  dose.
• 13:27
  And
• 13:28
  then
• 13:28
  they
• 13:28
  have
• 13:28
  this
• 13:28
  breakthrough
• 13:29
  psychosis.
• 13:29
  So
• 13:30
  that
• 13:30
  might
• 13:30
  be
• 13:30
  a
• 13:30
  deal
• 13:30
  breaker.
• 13:31
  Actually,
• 13:31
  you
• 13:31
  might
• 13:31
  have
• 13:32
  to
• 13:32
  keep
• 13:32
  them
• 13:32
  on
• 13:32
  the
• 13:32
  med,
• 13:33
  add
• 13:33
  a
• 13:33
  VMAT2
• 13:34
  inhibitor
• 13:34
  or
• 13:36
  switch
• 13:36
  them
• 13:36
  to
• 13:36
  a
• 13:36
  medication
• 13:37
  that
• 13:37
  doesn't
• 13:37
  blockade
• 13:38
  dopamine
• 13:39
  as
• 13:39
  fiercely.
• 13:40
  And
• 13:40
  again,
• 13:40
  we
• 13:40
  talked
• 13:41
  about
• 13:41
  clozapine,
• 13:41
  quetiapine.
• 13:42
  Again,
• 13:42
  you
• 13:43
  have
• 13:43
  to
• 13:43
  do
• 13:43
  that
• 13:43
  carefully,
• 13:44
  cautiously,
• 13:45
  if,
• 13:45
  if
• 13:46
  the
• 13:46
  case
• 13:46
  even
• 13:47
  indicates
• 13:47
  it.
• 13:48
  But
• 13:49
  at
• 13:49
  any
• 13:49
  rate,
• 13:50
  I
• 13:50
  hope
• 13:50
  you
• 13:50
  enjoyed
• 13:51
  this
• 13:51
  one.
• 13:51
  I
• 13:51
  hope
• 13:51
  it
• 13:51
  whet
• 13:51
  your
• 13:52
  appetite
• 13:52
  so
• 13:52
  that
• 13:53
  you
• 13:53
  can
• 13:53
  go
• 13:53
  in
• 13:53
  there
• 13:54
  and
• 13:55
  research
• 13:55
  a
• 13:55
  little
• 13:56
  more
• 13:56
  about
• 13:56
  tardive
• 13:56
  dyskinesia,
• 13:57
  how
• 13:57
  to
• 13:57
  assess
• 13:58
  it,
• 13:58
  who's,
• 13:59
  who's
• 13:59
  most
• 13:59
  vulnerable
• 14:01
  when
• 14:01
  it
• 14:01
  comes
• 14:01
  to
• 14:02
  td,
• 14:03
  what
• 14:03
  the
• 14:03
  treatments
• 14:04
  do,
• 14:04
  how
• 14:04
  they
• 14:04
  do
• 14:05
  it.
• 14:05
  We're
• 14:05
  going
• 14:05
  to
• 14:05
  go
• 14:05
  over
• 14:05
  all
• 14:06
  of
• 14:06
  that.
• 14:06
  It's
• 14:06
  going
• 14:06
  to
• 14:06
  be
• 14:07
  really
• 14:07
  exciting.
• 14:07
  And
• 14:08
  I
• 14:08
  think
• 14:08
  it's
• 14:08
  going
• 14:08
  to
• 14:08
  empower
• 14:08
  you
• 14:09
  to
• 14:10
  figure
• 14:10
  this
• 14:10
  out
• 14:10
  in
• 14:11
  clinic
• 14:11
  and
• 14:11
  not
• 14:11
  be
• 14:11
  intimidated
• 14:12
  by
• 14:12
  it.
• 14:12
  And
• 14:13
  as
• 14:13
  you
• 14:13
  all
• 14:13
  know,
• 14:14
  right,
• 14:15
  the
• 14:15
  whole
• 14:15
  point
• 14:16
  of
• 14:16
  this
• 14:16
  podcast
• 14:17
  is
• 14:17
  to
• 14:18
  make
• 14:18
  this
• 14:19
  visually
• 14:19
  sticky
• 14:20
  and
• 14:20
  beautiful
• 14:21
  so
• 14:21
  you
• 14:21
  just
• 14:21
  get
• 14:21
  it
• 14:21
  and
• 14:22
  you
• 14:22
  understand
• 14:22
  it
• 14:23
  and
• 14:23
  your
• 14:23
  patients
• 14:23
  will
• 14:24
  understand
• 14:24
  why
• 14:25
  you
• 14:25
  are
• 14:25
  doing
• 14:26
  specific
• 14:26
  things
• 14:27
  for
• 14:27
  specific
• 14:27
  reasons.
• 14:28
  That
• 14:28
  is
• 14:28
  why
• 14:29
  we
• 14:29
  made
• 14:29
  this
• 14:30
  podcast.
• 14:30
  That
• 14:30
  is
• 14:30
  also
• 14:31
  why
• 14:32
  we
• 14:33
  built
• 14:33
  our
• 14:33
  Patreon
• 14:34
  page.
• 14:35
  And
• 14:35
  before
• 14:36
  we
• 14:36
  go
• 14:36
  today,
• 14:37
  my
• 14:37
  friends,
• 14:37
  I
• 14:37
  just
• 14:37
  want
• 14:37
  to
• 14:38
  say
• 14:38
  one
• 14:38
  last
• 14:38
  thing.
• 14:39
  Now,
• 14:39
  I
• 14:39
  think
• 14:40
  we've
• 14:40
  all
• 14:40
  had
• 14:40
  moments
• 14:41
  in
• 14:41
  clinic
• 14:42
  where
• 14:42
  we
• 14:42
  know
• 14:42
  which
• 14:43
  med
• 14:43
  we're
• 14:44
  going
• 14:44
  to
• 14:44
  use,
• 14:44
  but
• 14:44
  maybe
• 14:45
  we
• 14:45
  struggle
• 14:45
  to
• 14:46
  explain
• 14:46
  why
• 14:46
  we're
• 14:47
  using
• 14:47
  it,
• 14:47
  why
• 14:48
  we're
• 14:48
  switching
• 14:48
  it,
• 14:49
  why
• 14:49
  a
• 14:49
  patient
• 14:49
  is
• 14:50
  having
• 14:50
  a
• 14:50
  particular
• 14:50
  side
• 14:51
  effect,
• 14:51
  why
• 14:51
  they
• 14:51
  feel
• 14:52
  sedated
• 14:52
  or
• 14:53
  activated
• 14:53
  or
• 14:53
  numb
• 14:54
  or
• 14:54
  restless
• 14:55
  or
• 14:55
  gains
• 14:55
  weight.
• 14:56
  Now,
• 14:57
  the
• 14:57
  difference
• 14:57
  between
• 14:58
  a
• 14:58
  good
• 14:58
  clinician
• 14:59
  and
• 14:59
  a
• 14:59
  great
• 14:59
  one
• 15:00
  is
• 15:00
  that
• 15:00
  the
• 15:00
  great
• 15:00
  one
• 15:01
  can
• 15:01
  explain
• 15:01
  why
• 15:02
  it's
• 15:02
  happening
• 15:02
  and
• 15:03
  can
• 15:03
  explain
• 15:04
  why
• 15:04
  we're
• 15:05
  changing
• 15:05
  course
• 15:05
  and
• 15:06
  how
• 15:06
  it's
• 15:07
  all
• 15:07
  happening.
• 15:08
  Patients
• 15:08
  smell
• 15:09
  that
• 15:09
  a
• 15:09
  mile
• 15:09
  away.
• 15:10
  And
• 15:10
  that's
• 15:11
  why
• 15:11
  we
• 15:11
  built
• 15:12
  this
• 15:12
  Patreon
• 15:12
  library.
• 15:13
  So
• 15:13
  you
• 15:13
  become
• 15:13
  the
• 15:14
  clinician
• 15:14
  who
• 15:15
  understands
• 15:15
  the
• 15:16
  how
• 15:16
  and
• 15:16
  the
• 15:16
  why.
• 15:16
  And
• 15:17
  can
• 15:17
  explain
• 15:17
  it.
• 15:18
  And
• 15:18
  you're
• 15:18
  not
• 15:18
  just
• 15:18
  pressing
• 15:19
  buttons.
• 15:20
  That's
• 15:21
  the
• 15:21
  goal.
• 15:21
  That's
• 15:22
  why
• 15:22
  we
• 15:22
  built
• 15:22
  this
• 15:22
  library.
• 15:23
  And
• 15:24
  so
• 15:25
  go
• 15:25
  over
• 15:25
  to
• 15:25
  the
• 15:25
  Show
• 15:25
  Notes,
• 15:26
  click
• 15:27
  our
• 15:27
  link,
• 15:27
  join
• 15:28
  Patreon.
• 15:28
  Become
• 15:28
  a
• 15:29
  member.
• 15:29
  You
• 15:29
  will
• 15:29
  not
• 15:30
  regret
• 15:30
  it.
• 15:30
  It
• 15:30
  will
• 15:30
  transform
• 15:31
  the
• 15:31
  way
• 15:31
  you
• 15:31
  practice.
• 15:32
  That's
• 15:32
  patreon.com
• 15:34
  pearlsandprep
• 15:35
  thank
• 15:36
  you
• 15:36
  all
• 15:36
  very
• 15:36
  much
• 15:37
  for
• 15:37
  tuning
• 15:37
  in
• 15:37
  to
• 15:37
  another
• 15:38
  episode
• 15:38
  of
• 15:39
  Pearls
• 15:39
  and
• 15:39
  prep
• 15:40
  Take.