Latest / Pearls and Prep / BONUS EPISODE: Bouncers, Crowds, and Chaos: Affinity, Occupancy, and Intrinsic Activity Explained

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BONUS EPISODE: Bouncers, Crowds, and Chaos: Affinity, Occupancy, and Intrinsic Activity Explained · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back,
• 0:06
  my
• 0:06
  friends,
• 0:06
  to
• 0:06
  another
• 0:07
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:08
  Prep.
• 0:08
  This
• 0:08
  is
• 0:09
  npc
• 0:09
  here,
• 0:09
  your
• 0:10
  preceptor
• 0:10
  in
• 0:10
  your
• 0:11
  pocket.
• 0:11
  This
• 0:12
  is
• 0:12
  your
• 0:12
  go
• 0:13
  to
• 0:13
  place
• 0:13
  for
• 0:14
  pearls
• 0:14
  that
• 0:15
  prep
• 0:15
  you
• 0:16
  to
• 0:16
  practice.
• 0:17
  Well,
• 0:17
  we
• 0:17
  have
• 0:18
  rolled
• 0:18
  out
• 0:18
  some
• 0:19
  really
• 0:19
  cool
• 0:19
  episodes
• 0:20
  on
• 0:20
  affinity,
• 0:21
  occupancy
• 0:22
  and
• 0:22
  intrinsic
• 0:23
  activity.
• 0:24
  And
• 0:24
  those
• 0:25
  three
• 0:25
  words
• 0:25
  might
• 0:26
  feel
• 0:27
  really
• 0:27
  disorienting
• 0:28
  to
• 0:28
  you
• 0:28
  right
• 0:29
  now,
• 0:29
  and
• 0:29
  that's
• 0:29
  okay.
• 0:30
  I
• 0:30
  encourage
• 0:31
  you
• 0:31
  to
• 0:31
  go
• 0:31
  back
• 0:31
  into
• 0:32
  our
• 0:32
  library
• 0:32
  and
• 0:33
  listen
• 0:33
  and
• 0:33
  re
• 0:33
  listen
• 0:34
  to
• 0:34
  them
• 0:34
  and
• 0:35
  dig
• 0:35
  deep
• 0:36
  into
• 0:36
  those
• 0:36
  three
• 0:36
  topics
• 0:37
  because
• 0:37
  they're
• 0:37
  very
• 0:37
  important
• 0:38
  and
• 0:38
  they're
• 0:38
  very
• 0:38
  fundamental.
• 0:39
  But
• 0:39
  today
• 0:40
  is
• 0:40
  a
• 0:41
  bonus
• 0:42
  episode
• 0:43
  to
• 0:43
  kind
• 0:43
  of
• 0:44
  unify
• 0:44
  all
• 0:45
  three
• 0:45
  of
• 0:45
  those
• 0:46
  concepts
• 0:47
  into
• 0:48
  an
• 0:48
  analogy
• 0:49
  because,
• 0:49
  you
• 0:49
  know,
• 0:50
  I
• 0:50
  love
• 0:50
  analogies.
• 0:52
  And
• 0:52
  so
• 0:52
  hopefully
• 0:53
  this
• 0:53
  clicks
• 0:53
  a
• 0:53
  little
• 0:53
  bit
• 0:54
  better
• 0:54
  and
• 0:55
  gives
• 0:55
  you
• 0:55
  a
• 0:55
  little
• 0:56
  more
• 0:56
  insight
• 0:57
  into
• 0:57
  what
• 0:57
  the
• 0:58
  heck
• 0:58
  we're
• 0:58
  prescribing
• 0:59
  and
• 0:59
  why
• 0:59
  and
• 1:00
  how
• 1:00
  this
• 1:00
  all
• 1:00
  works.
• 1:01
  Okay?
• 1:02
  So
• 1:03
  my
• 1:03
  friends,
• 1:04
  let's
• 1:04
  compare
• 1:05
  occupancy,
• 1:06
  intrinsic
• 1:07
  activity,
• 1:09
  okay?
• 1:10
  And
• 1:10
  affinity
• 1:11
  to
• 1:12
  a
• 1:12
  nightclub.
• 1:13
  Okay?
• 1:14
  Now
• 1:14
  the
• 1:14
  nightclub
• 1:15
  is
• 1:15
  like
• 1:15
  the
• 1:16
  brain,
• 1:16
  okay?
• 1:18
  And
• 1:18
  in
• 1:19
  the
• 1:19
  nightclub
• 1:19
  there
• 1:19
  are
• 1:20
  VIP
• 1:20
  tables
• 1:21
  or
• 1:21
  receptors,
• 1:22
  okay?
• 1:23
  And
• 1:24
  for
• 1:24
  simplicity's
• 1:25
  sake,
• 1:25
  we're
• 1:25
  gonna
• 1:25
  talk
• 1:26
  about
• 1:26
  D2
• 1:27
  dopamine
• 1:27
  receptors
• 1:28
  in
• 1:28
  this
• 1:28
  analogy.
• 1:29
  So
• 1:29
  just
• 1:29
  imagine
• 1:30
  those
• 1:30
  VIP
• 1:30
  tables
• 1:31
  are
• 1:31
  like
• 1:31
  D2
• 1:32
  receptors.
• 1:32
  So
• 1:33
  all
• 1:33
  the
• 1:33
  tables
• 1:33
  represent
• 1:34
  a
• 1:34
  D2
• 1:34
  receptor.
• 1:35
  So
• 1:35
  again,
• 1:35
  the
• 1:36
  nightclub
• 1:36
  is
• 1:36
  the
• 1:36
  brain
• 1:37
  inside
• 1:38
  of
• 1:38
  the
• 1:38
  brain.
• 1:39
  You
• 1:39
  have
• 1:39
  D2
• 1:39
  receptors
• 1:40
  or
• 1:40
  VIP
• 1:41
  tables,
• 1:41
  okay?
• 1:42
  Now
• 1:42
  I
• 1:42
  want
• 1:43
  you
• 1:43
  to
• 1:43
  imagine
• 1:44
  somebody
• 1:44
  who's
• 1:44
  psychotic
• 1:46
  and
• 1:46
  imagine
• 1:47
  that
• 1:47
  nightclub
• 1:47
  is
• 1:48
  just
• 1:48
  raving.
• 1:49
  There's
• 1:50
  way
• 1:50
  too
• 1:50
  much
• 1:51
  dopaminergic
• 1:52
  activity.
• 1:53
  There's
• 1:53
  wild
• 1:53
  partying
• 1:54
  and
• 1:54
  thrashing.
• 1:55
  People
• 1:55
  are
• 1:55
  dancing
• 1:56
  on
• 1:56
  the
• 1:56
  tables.
• 1:56
  They're
• 1:56
  ordering
• 1:57
  nine
• 1:57
  bottles
• 1:58
  of
• 1:58
  Grey
• 1:58
  Goose.
• 1:59
  The
• 1:59
  music
• 1:59
  is
• 1:59
  crazy,
• 2:00
  the
• 2:00
  strobe
• 2:00
  lights
• 2:01
  are
• 2:01
  all
• 2:01
  are.
• 2:02
  Are
• 2:02
  flashing
• 2:03
  all
• 2:03
  over
• 2:03
  the
• 2:03
  place.
• 2:03
  There's
• 2:04
  smoke
• 2:05
  machines,
• 2:06
  people
• 2:06
  are
• 2:07
  dressed
• 2:07
  in
• 2:07
  leopard
• 2:08
  skin.
• 2:09
  Maybe
• 2:09
  there's
• 2:10
  death
• 2:10
  metal.
• 2:11
  But
• 2:11
  you
• 2:11
  know,
• 2:11
  this
• 2:11
  is
• 2:11
  what
• 2:12
  we
• 2:12
  had
• 2:12
  imagined
• 2:12
  with
• 2:12
  just
• 2:13
  a
• 2:13
  wild,
• 2:14
  crazy,
• 2:15
  thrashing
• 2:16
  nightclub,
• 2:17
  okay?
• 2:17
  And
• 2:18
  that
• 2:18
  would
• 2:18
  be
• 2:18
  like
• 2:19
  dopaminergic
• 2:20
  activity
• 2:20
  that
• 2:20
  is
• 2:21
  way
• 2:21
  too
• 2:21
  excessive
• 2:22
  in
• 2:23
  the
• 2:23
  nightclub.
• 2:24
  Well,
• 2:24
  if
• 2:25
  you're
• 2:25
  prescribing
• 2:25
  a
• 2:25
  medication,
• 2:26
  you
• 2:26
  definitely
• 2:27
  want
• 2:27
  to
• 2:27
  tone
• 2:27
  that
• 2:28
  down,
• 2:28
  right?
• 2:29
  And
• 2:29
  so
• 2:30
  there's
• 2:31
  of
• 2:31
  course,
• 2:31
  many
• 2:31
  ways
• 2:32
  to
• 2:32
  do
• 2:32
  that.
• 2:32
  Now,
• 2:32
  the
• 2:33
  first
• 2:33
  thing
• 2:33
  you
• 2:33
  would
• 2:33
  need
• 2:34
  to
• 2:34
  do
• 2:35
  just
• 2:35
  off
• 2:35
  the
• 2:35
  bat
• 2:36
  is
• 2:36
  you
• 2:36
  want
• 2:36
  to
• 2:36
  pick
• 2:36
  a
• 2:36
  medication
• 2:37
  ideally
• 2:39
  that
• 2:39
  has
• 2:39
  a
• 2:39
  strong
• 2:40
  affinity
• 2:40
  for
• 2:40
  the
• 2:40
  D2
• 2:41
  receptor,
• 2:41
  right?
• 2:41
  Because
• 2:42
  if
• 2:42
  you
• 2:42
  send
• 2:42
  in
• 2:42
  a
• 2:42
  medication
• 2:43
  that
• 2:44
  has
• 2:44
  no
• 2:44
  affinity
• 2:45
  to
• 2:45
  the
• 2:45
  D2
• 2:45
  receptor,
• 2:46
  well,
• 2:46
  you're
• 2:46
  not
• 2:47
  going
• 2:47
  to
• 2:47
  stop
• 2:47
  these,
• 2:48
  this
• 2:48
  wild,
• 2:48
  crazy
• 2:49
  party
• 2:49
  at
• 2:49
  these
• 2:50
  VIP
• 2:50
  tables
• 2:51
  from.
• 2:51
  Stop.
• 2:51
  You're
• 2:52
  not
• 2:52
  going
• 2:52
  to
• 2:52
  stop
• 2:52
  them.
• 2:53
  It's
• 2:53
  going
• 2:53
  to
• 2:53
  Keep
• 2:53
  raging
• 2:54
  on
• 2:54
  and
• 2:54
  there's
• 2:55
  going
• 2:55
  to
• 2:55
  be
• 2:55
  chaos
• 2:55
  in
• 2:55
  the
• 2:56
  nightclub
• 2:56
  or
• 2:57
  a.k.a.
• 2:57
  The
• 2:57
  brain,
• 2:58
  right?
• 2:59
  So
• 2:59
  that's
• 3:00
  why
• 3:00
  it's
• 3:00
  so
• 3:00
  important
• 3:01
  to
• 3:01
  know
• 3:01
  your
• 3:01
  medications
• 3:02
  and
• 3:02
  know
• 3:02
  which
• 3:03
  ones
• 3:03
  have
• 3:04
  a
• 3:04
  strong
• 3:04
  affinity
• 3:05
  for
• 3:06
  your
• 3:06
  target
• 3:07
  receptors,
• 3:09
  right?
• 3:09
  Your
• 3:09
  target
• 3:10
  receptors.
• 3:10
  In
• 3:10
  this
• 3:11
  case,
• 3:11
  it
• 3:11
  would
• 3:11
  be
• 3:11
  D2,
• 3:12
  okay?
• 3:13
  And
• 3:13
  that
• 3:13
  really
• 3:14
  helps
• 3:14
  you
• 3:14
  understand,
• 3:15
  just
• 3:15
  as
• 3:15
  a
• 3:16
  sort
• 3:16
  of
• 3:16
  a.
• 3:16
  An
• 3:17
  opening
• 3:18
  idea,
• 3:19
  which
• 3:19
  medications
• 3:20
  will
• 3:20
  be
• 3:20
  effective
• 3:21
  here.
• 3:21
  D2,
• 3:22
  okay?
• 3:22
  If
• 3:23
  you
• 3:23
  have
• 3:23
  a
• 3:23
  medication
• 3:23
  that
• 3:24
  is
• 3:24
  not.
• 3:24
  That
• 3:25
  has
• 3:25
  a
• 3:25
  very
• 3:25
  low
• 3:25
  affinity
• 3:26
  for
• 3:26
  D2,
• 3:27
  well,
• 3:27
  that
• 3:27
  could
• 3:28
  be.
• 3:28
  That
• 3:28
  could
• 3:28
  certainly
• 3:29
  be
• 3:29
  a
• 3:29
  problem.
• 3:30
  Okay?
• 3:30
  In
• 3:30
  this
• 3:30
  case,
• 3:30
  we
• 3:31
  want
• 3:31
  a
• 3:31
  really
• 3:31
  good
• 3:32
  D2
• 3:33
  affinity
• 3:34
  medication.
• 3:34
  And
• 3:35
  in
• 3:35
  my
• 3:35
  analogy,
• 3:36
  I
• 3:36
  liken
• 3:36
  this
• 3:37
  to
• 3:37
  like
• 3:37
  a
• 3:37
  bouncer
• 3:38
  that
• 3:38
  comes
• 3:38
  in
• 3:38
  and
• 3:38
  restores
• 3:39
  order
• 3:40
  into
• 3:40
  the
• 3:40
  nightclub,
• 3:41
  okay?
• 3:41
  And
• 3:42
  one
• 3:42
  good
• 3:42
  example
• 3:42
  of
• 3:43
  that
• 3:43
  bouncer
• 3:43
  would
• 3:43
  be
• 3:43
  like,
• 3:44
  Haldol.
• 3:44
  Haldol
• 3:45
  is
• 3:45
  a
• 3:45
  really
• 3:46
  good
• 3:46
  bouncer,
• 3:47
  okay?
• 3:47
  It's
• 3:48
  a
• 3:48
  full
• 3:48
  antagonist
• 3:49
  and
• 3:49
  we'll
• 3:49
  get
• 3:49
  into
• 3:49
  that
• 3:49
  a
• 3:50
  little
• 3:50
  bit
• 3:50
  later,
• 3:50
  but
• 3:50
  we're
• 3:50
  talking
• 3:51
  about
• 3:51
  affinity
• 3:51
  right
• 3:51
  now,
• 3:52
  okay?
• 3:53
  So
• 3:53
  affinity.
• 3:54
  Haldol
• 3:55
  has
• 3:55
  a
• 3:55
  very
• 3:55
  high
• 3:56
  affinity
• 3:56
  for
• 3:56
  D2.
• 3:57
  So
• 3:57
  halidol
• 3:57
  will
• 3:58
  reliably
• 3:59
  walk
• 3:59
  into
• 3:59
  this
• 4:00
  club
• 4:01
  and
• 4:02
  yank
• 4:02
  those
• 4:02
  guys
• 4:03
  off
• 4:03
  the
• 4:03
  table
• 4:03
  and
• 4:04
  restore
• 4:04
  order
• 4:05
  rather
• 4:05
  quickly,
• 4:06
  okay?
• 4:07
  That's
• 4:07
  the
• 4:07
  key.
• 4:08
  And
• 4:08
  just
• 4:09
  to
• 4:09
  refresh,
• 4:10
  if
• 4:10
  you're
• 4:10
  scratching
• 4:11
  your
• 4:11
  head
• 4:11
  about
• 4:11
  affinity,
• 4:12
  just
• 4:12
  remember
• 4:12
  it's
• 4:12
  the
• 4:13
  strength
• 4:13
  of
• 4:13
  binding
• 4:14
  between
• 4:14
  a
• 4:14
  drug
• 4:14
  and
• 4:14
  its
• 4:15
  receptor,
• 4:15
  okay?
• 4:16
  And
• 4:16
  it's
• 4:17
  usually
• 4:17
  qualified
• 4:17
  by
• 4:18
  the
• 4:18
  disassociation
• 4:19
  constant,
• 4:19
  kd,
• 4:20
  okay?
• 4:21
  And
• 4:22
  the
• 4:22
  lower
• 4:22
  the
• 4:22
  KD
• 4:23
  you
• 4:23
  see
• 4:23
  in
• 4:23
  your
• 4:23
  textbooks,
• 4:24
  the
• 4:24
  higher
• 4:24
  the
• 4:24
  affinity,
• 4:25
  okay?
• 4:26
  So
• 4:27
  Haldol
• 4:28
  has,
• 4:28
  again,
• 4:28
  a
• 4:28
  very
• 4:28
  high
• 4:29
  affinity
• 4:29
  for
• 4:29
  dt.
• 4:30
  So
• 4:30
  it's
• 4:30
  a
• 4:30
  very
• 4:31
  effective
• 4:31
  bouncer.
• 4:32
  Haldol's
• 4:32
  gonna
• 4:33
  walk
• 4:33
  into
• 4:33
  the
• 4:33
  nightclub,
• 4:34
  yank
• 4:34
  those
• 4:34
  folks
• 4:35
  off
• 4:35
  of
• 4:35
  the
• 4:35
  tables,
• 4:35
  they're
• 4:36
  gonna
• 4:36
  stop
• 4:36
  dancing.
• 4:37
  However,
• 4:38
  if
• 4:39
  you
• 4:39
  put
• 4:39
  too
• 4:39
  many
• 4:40
  of
• 4:40
  the
• 4:41
  bouncers
• 4:41
  into
• 4:41
  the
• 4:42
  nightclub,
• 4:43
  right?
• 4:43
  If
• 4:43
  you
• 4:44
  send
• 4:44
  too
• 4:44
  much
• 4:44
  too
• 4:45
  many
• 4:45
  of
• 4:45
  these
• 4:45
  bouncers
• 4:46
  into
• 4:46
  the
• 4:47
  nightclub
• 4:47
  and
• 4:47
  they
• 4:48
  go
• 4:48
  to.
• 4:48
  They
• 4:48
  occupy.
• 4:49
  Hence,
• 4:49
  we're.
• 4:50
  We're
• 4:50
  transitioning
• 4:50
  to
• 4:50
  occupancy
• 4:51
  here.
• 4:52
  A
• 4:53
  way
• 4:53
  too
• 4:53
  high
• 4:53
  of
• 4:54
  a
• 4:54
  fraction
• 4:54
  of
• 4:54
  the
• 4:54
  tables.
• 4:55
  Now
• 4:56
  you
• 4:56
  kind
• 4:56
  of
• 4:56
  have
• 4:56
  a
• 4:56
  problem,
• 4:57
  right?
• 4:57
  You're
• 4:58
  going
• 4:58
  to
• 4:58
  have.
• 4:58
  On
• 4:58
  the,
• 4:59
  on
• 4:59
  the.
• 4:59
  On
• 4:59
  the
• 4:59
  plus
• 5:00
  side,
• 5:01
  the
• 5:01
  party's
• 5:01
  going
• 5:01
  to
• 5:02
  get.
• 5:03
  Get
• 5:04
  kicked
• 5:04
  back.
• 5:05
  Like,
• 5:05
  the
• 5:05
  party's
• 5:05
  going
• 5:06
  to
• 5:07
  get
• 5:07
  really
• 5:07
  quiet
• 5:08
  really
• 5:08
  fast,
• 5:08
  right?
• 5:08
  These
• 5:08
  are
• 5:09
  really
• 5:09
  tough
• 5:09
  bouncers.
• 5:10
  They
• 5:10
  have
• 5:10
  a
• 5:10
  strong
• 5:10
  affinity
• 5:11
  for
• 5:11
  D2.
• 5:12
  D2
• 5:12
  are
• 5:12
  your
• 5:12
  VIP
• 5:13
  tables
• 5:13
  where
• 5:13
  there's
• 5:14
  way
• 5:14
  too
• 5:14
  much
• 5:14
  wild
• 5:15
  thrashing
• 5:16
  leopard
• 5:16
  party,
• 5:17
  Grey
• 5:17
  goose
• 5:18
  guzzling
• 5:19
  madness
• 5:19
  going
• 5:19
  on,
• 5:20
  right?
• 5:20
  So
• 5:20
  you've
• 5:20
  sent
• 5:21
  these
• 5:21
  high
• 5:22
  affinities.
• 5:22
  Bouncers
• 5:23
  are
• 5:23
  just
• 5:23
  so
• 5:24
  mad
• 5:24
  at
• 5:25
  have
• 5:25
  they're
• 5:25
  they're
• 5:25
  so
• 5:26
  fed
• 5:26
  up
• 5:26
  with
• 5:27
  the
• 5:27
  chaos,
• 5:27
  particularly
• 5:28
  at
• 5:28
  those
• 5:29
  VIP
• 5:29
  tables,
• 5:30
  those
• 5:30
  D2
• 5:30
  tables,
• 5:31
  right?
• 5:32
  Maybe
• 5:32
  they're
• 5:32
  not
• 5:32
  interested
• 5:33
  in
• 5:33
  some
• 5:33
  of
• 5:33
  the
• 5:33
  other
• 5:33
  tables
• 5:34
  in
• 5:34
  the
• 5:34
  nightclub,
• 5:35
  some
• 5:35
  of
• 5:35
  the
• 5:35
  other
• 5:35
  receptors.
• 5:36
  They're
• 5:36
  exclusively
• 5:37
  interested
• 5:38
  in
• 5:38
  the
• 5:39
  madness
• 5:39
  that's
• 5:39
  happening
• 5:40
  and
• 5:40
  the
• 5:40
  particular
• 5:41
  guests
• 5:41
  that
• 5:41
  are
• 5:41
  dancing
• 5:42
  on,
• 5:42
  on,
• 5:42
  on
• 5:43
  these
• 5:43
  tables,
• 5:43
  these
• 5:43
  D2
• 5:44
  tables.
• 5:44
  So
• 5:45
  they
• 5:45
  go
• 5:45
  in
• 5:45
  there,
• 5:45
  they
• 5:46
  throw
• 5:46
  them
• 5:46
  out.
• 5:46
  But
• 5:46
  now
• 5:47
  you
• 5:47
  send
• 5:47
  in
• 5:47
  too
• 5:48
  much
• 5:48
  of
• 5:48
  this
• 5:48
  Haldol.
• 5:49
  Another
• 5:49
  way
• 5:49
  of
• 5:49
  saying
• 5:49
  that
• 5:50
  is,
• 5:50
  is
• 5:50
  your
• 5:50
  dose
• 5:51
  might
• 5:51
  be
• 5:51
  too
• 5:51
  high.
• 5:51
  And
• 5:52
  if
• 5:52
  that's
• 5:52
  the
• 5:52
  case
• 5:53
  now
• 5:53
  you're,
• 5:54
  you
• 5:54
  have
• 5:54
  too
• 5:54
  many
• 5:54
  bouncers
• 5:55
  at
• 5:55
  too
• 5:55
  many
• 5:55
  tables.
• 5:56
  So
• 5:56
  of
• 5:56
  the
• 5:56
  hundred
• 5:56
  tables,
• 5:57
  you've
• 5:57
  got
• 5:57
  like
• 5:58
  95
• 5:58
  of
• 5:58
  them
• 5:59
  swarming,
• 5:59
  swarmed
• 6:00
  with
• 6:00
  these
• 6:01
  bouncers,
• 6:02
  okay?
• 6:02
  These
• 6:02
  big
• 6:02
  muscly
• 6:03
  bouncers.
• 6:04
  And
• 6:04
  now
• 6:04
  your
• 6:04
  party
• 6:05
  is
• 6:05
  too
• 6:05
  stiff.
• 6:06
  It's
• 6:07
  too
• 6:07
  dead.
• 6:07
  The
• 6:07
  music
• 6:07
  is,
• 6:08
  is,
• 6:09
  you
• 6:09
  know,
• 6:10
  there
• 6:10
  is
• 6:10
  no
• 6:10
  more
• 6:10
  music,
• 6:11
  there's
• 6:11
  no
• 6:11
  more
• 6:11
  beats,
• 6:12
  there's
• 6:12
  no
• 6:12
  more
• 6:12
  fog
• 6:13
  machine,
• 6:14
  there's
• 6:14
  no
• 6:14
  strobe
• 6:14
  lights.
• 6:15
  Everybody,
• 6:16
  like,
• 6:16
  the
• 6:16
  party's
• 6:16
  over,
• 6:17
  right?
• 6:17
  But
• 6:17
  it's
• 6:18
  too
• 6:18
  stiff,
• 6:19
  Hence
• 6:19
  your
• 6:20
  EPS
• 6:20
  symptoms,
• 6:21
  your
• 6:21
  rigid
• 6:21
  muscles,
• 6:22
  your
• 6:22
  tremors,
• 6:22
  because
• 6:23
  too
• 6:23
  many
• 6:23
  of
• 6:23
  the
• 6:23
  receptors
• 6:24
  are
• 6:24
  blocked
• 6:24
  and
• 6:24
  other
• 6:25
  blocked.
• 6:25
  In
• 6:25
  other
• 6:25
  words,
• 6:26
  you
• 6:26
  have
• 6:26
  occupied
• 6:27
  too
• 6:27
  many
• 6:28
  of
• 6:29
  the
• 6:29
  seats
• 6:30
  with
• 6:30
  a
• 6:30
  high
• 6:31
  affinity
• 6:32
  antagonist,
• 6:33
  okay?
• 6:33
  A
• 6:34
  high
• 6:34
  affinity
• 6:34
  D2
• 6:35
  antagonist
• 6:36
  in
• 6:36
  particular,
• 6:37
  Haldol,
• 6:37
  right?
• 6:38
  It's
• 6:38
  a
• 6:38
  first
• 6:38
  generation
• 6:38
  antipsychotic.
• 6:40
  So
• 6:40
  that's
• 6:40
  a
• 6:41
  bit
• 6:41
  of
• 6:41
  a
• 6:41
  problem,
• 6:42
  right?
• 6:42
  You,
• 6:42
  you've
• 6:43
  blocked
• 6:43
  80%
• 6:44
  of
• 6:44
  the
• 6:44
  tables
• 6:45
  or
• 6:45
  more.
• 6:45
  That's
• 6:46
  a
• 6:46
  danger
• 6:46
  zone.
• 6:46
  Too
• 6:47
  high
• 6:47
  of
• 6:47
  a
• 6:47
  dose,
• 6:48
  okay?
• 6:48
  They've
• 6:49
  locked
• 6:49
  down
• 6:49
  the
• 6:49
  entire
• 6:50
  club.
• 6:50
  The
• 6:50
  vibe
• 6:51
  is
• 6:51
  dead.
• 6:51
  There's
• 6:51
  no
• 6:51
  more
• 6:52
  wild
• 6:52
  partying.
• 6:52
  And
• 6:53
  now
• 6:53
  the
• 6:53
  party's
• 6:53
  actually
• 6:54
  way
• 6:54
  too
• 6:54
  stiff.
• 6:55
  So
• 6:55
  you
• 6:55
  really
• 6:55
  want
• 6:56
  to,
• 6:56
  in
• 6:56
  order
• 6:56
  to,
• 6:57
  to.
• 6:57
  To
• 6:57
  kind
• 6:57
  of
• 6:57
  have
• 6:58
  reach
• 6:58
  a
• 6:58
  Goldilock
• 6:59
  zone
• 6:59
  here,
• 6:59
  Here.
• 6:59
  You
• 7:00
  really
• 7:00
  want
• 7:00
  the
• 7:00
  bouncers
• 7:01
  to
• 7:01
  take
• 7:01
  over
• 7:01
  just
• 7:01
  enough
• 7:02
  tables
• 7:02
  to
• 7:02
  stop
• 7:03
  kind
• 7:03
  of
• 7:03
  the
• 7:03
  wild,
• 7:03
  dangerous
• 7:04
  thrashing,
• 7:05
  but
• 7:05
  you
• 7:05
  still
• 7:06
  need,
• 7:06
  you
• 7:07
  know,
• 7:07
  a
• 7:07
  few
• 7:07
  tables
• 7:08
  to
• 7:08
  be
• 7:09
  bouncing
• 7:09
  around
• 7:09
  and
• 7:09
  having
• 7:10
  fun.
• 7:10
  This
• 7:10
  is
• 7:10
  why
• 7:11
  in
• 7:11
  psychopharmacology
• 7:12
  we
• 7:12
  want
• 7:13
  to
• 7:14
  occupy
• 7:15
  just
• 7:15
  enough
• 7:16
  of
• 7:17
  these
• 7:17
  tables
• 7:18
  to
• 7:18
  restore
• 7:18
  order,
• 7:19
  but
• 7:19
  not
• 7:19
  too
• 7:19
  many
• 7:20
  of
• 7:20
  them
• 7:20
  to
• 7:20
  where
• 7:20
  the
• 7:20
  party
• 7:21
  is
• 7:21
  dead,
• 7:21
  right?
• 7:22
  We
• 7:22
  also
• 7:22
  don't
• 7:22
  want
• 7:23
  to
• 7:23
  ignore
• 7:23
  too
• 7:23
  many
• 7:23
  of
• 7:24
  the
• 7:24
  tables.
• 7:24
  So
• 7:24
  if
• 7:24
  we
• 7:24
  didn't
• 7:25
  block
• 7:25
  enough
• 7:25
  of
• 7:25
  these
• 7:26
  tables,
• 7:26
  let's
• 7:26
  say
• 7:26
  we
• 7:26
  give
• 7:26
  seroquel
• 7:27
  at
• 7:27
  like
• 7:28
  50
• 7:28
  milligrams.
• 7:28
  Oh,
• 7:29
  it's
• 7:29
  an
• 7:29
  antipsychotic.
• 7:30
  Oh,
• 7:30
  this
• 7:30
  is
• 7:30
  going
• 7:31
  to
• 7:31
  really
• 7:31
  help
• 7:31
  restore
• 7:32
  order
• 7:32
  in
• 7:32
  the
• 7:32
  party.
• 7:33
  Well,
• 7:33
  you've
• 7:33
  kind
• 7:33
  of
• 7:33
  sent
• 7:33
  like
• 7:34
  a
• 7:34
  couple
• 7:35
  bouncers
• 7:35
  in
• 7:35
  who
• 7:35
  don't
• 7:36
  lift
• 7:36
  weights
• 7:37
  and
• 7:37
  they're
• 7:37
  not
• 7:37
  really
• 7:37
  able
• 7:38
  to
• 7:38
  wrestle
• 7:38
  those
• 7:38
  people
• 7:39
  off
• 7:40
  of
• 7:40
  the
• 7:40
  tables
• 7:41
  fast
• 7:41
  enough.
• 7:42
  They're
• 7:42
  still
• 7:42
  dancing,
• 7:43
  they're
• 7:43
  hooting
• 7:43
  and
• 7:43
  hollering.
• 7:44
  And
• 7:44
  you
• 7:44
  sent
• 7:45
  kind
• 7:45
  of
• 7:45
  a
• 7:45
  scrawny
• 7:46
  bouncer
• 7:47
  over
• 7:47
  to
• 7:47
  the
• 7:47
  table.
• 7:48
  You're
• 7:48
  going
• 7:48
  to
• 7:48
  have
• 7:48
  to
• 7:48
  send
• 7:49
  a
• 7:49
  lot
• 7:49
  more
• 7:49
  bouncers,
• 7:50
  if
• 7:50
  you're
• 7:51
  talking
• 7:51
  Seroquel,
• 7:52
  a
• 7:52
  lot
• 7:52
  more,
• 7:53
  in
• 7:54
  order
• 7:54
  to
• 7:54
  really
• 7:54
  restore
• 7:55
  order
• 7:55
  in
• 7:55
  that
• 7:55
  party.
• 7:56
  That's
• 7:56
  how
• 7:56
  we
• 7:56
  know,
• 7:56
  like,
• 7:57
  the
• 7:57
  6
• 7:57
  to
• 7:57
  800
• 7:58
  range
• 7:58
  is
• 7:59
  typically
• 7:59
  more
• 7:59
  antipsychotic,
• 8:00
  right?
• 8:00
  So
• 8:00
  in
• 8:01
  order
• 8:01
  to
• 8:01
  really
• 8:02
  restore
• 8:02
  order,
• 8:03
  the
• 8:03
  Seroquel's
• 8:04
  gotta.
• 8:04
  You've
• 8:05
  gotta
• 8:05
  raise
• 8:05
  that
• 8:05
  dose.
• 8:05
  Many
• 8:06
  more
• 8:06
  bouncers
• 8:07
  to
• 8:07
  occupy
• 8:07
  the
• 8:08
  entire
• 8:08
  nightclub
• 8:08
  and
• 8:09
  restore
• 8:09
  order.
• 8:09
  With
• 8:09
  Haldol,
• 8:10
  it's
• 8:10
  a
• 8:10
  bit
• 8:10
  less.
• 8:11
  It's
• 8:11
  a
• 8:11
  very
• 8:11
  strong
• 8:12
  antagonist.
• 8:13
  Remember,
• 8:13
  it
• 8:14
  has
• 8:14
  a
• 8:14
  high
• 8:14
  affinity.
• 8:14
  So
• 8:15
  it's
• 8:15
  like
• 8:15
  laser
• 8:15
  beamed
• 8:16
  to
• 8:16
  those
• 8:17
  tables
• 8:17
  where
• 8:17
  the
• 8:18
  party
• 8:18
  is
• 8:19
  getting
• 8:19
  too
• 8:19
  chaotic.
• 8:20
  But
• 8:20
  again,
• 8:20
  you
• 8:20
  can
• 8:20
  have
• 8:21
  a
• 8:21
  heavy
• 8:21
  hand
• 8:21
  with
• 8:21
  Haldol
• 8:22
  and
• 8:23
  block
• 8:23
  too
• 8:23
  much,
• 8:24
  right?
• 8:24
  So
• 8:24
  we've
• 8:24
  talked
• 8:25
  about
• 8:25
  affinity,
• 8:25
  occupancy.
• 8:26
  Intrinsic
• 8:26
  activity
• 8:27
  now
• 8:27
  is
• 8:28
  the
• 8:28
  ability
• 8:28
  of
• 8:28
  a
• 8:28
  drug
• 8:29
  receptor
• 8:29
  complex
• 8:30
  to
• 8:30
  produce
• 8:30
  a
• 8:30
  biological
• 8:31
  response
• 8:31
  once
• 8:32
  it's
• 8:32
  bound.
• 8:33
  So
• 8:33
  this
• 8:33
  is.
• 8:33
  There's
• 8:33
  no
• 8:34
  need
• 8:34
  to
• 8:34
  really
• 8:34
  overthink
• 8:35
  this,
• 8:35
  right?
• 8:35
  We're
• 8:36
  talking
• 8:36
  about
• 8:37
  really,
• 8:38
  agonism,
• 8:39
  antagonism,
• 8:40
  or
• 8:41
  partial
• 8:41
  agonism,
• 8:42
  right?
• 8:42
  You've
• 8:43
  seen
• 8:43
  this
• 8:43
  all
• 8:43
  over
• 8:43
  your
• 8:43
  textbooks,
• 8:44
  right?
• 8:45
  So
• 8:45
  Haldol,
• 8:45
  of
• 8:45
  course,
• 8:46
  has
• 8:46
  zero
• 8:47
  intrinsic
• 8:47
  activity
• 8:48
  at
• 8:48
  D2.
• 8:48
  So
• 8:49
  it's
• 8:49
  a
• 8:49
  pure
• 8:49
  antagonist.
• 8:50
  Okay?
• 8:51
  So
• 8:51
  again,
• 8:52
  it.
• 8:52
  It
• 8:52
  goes
• 8:53
  to
• 8:53
  the
• 8:53
  table
• 8:53
  and
• 8:53
  it
• 8:53
  just
• 8:54
  shuts
• 8:54
  it
• 8:54
  down.
• 8:54
  Partial
• 8:55
  agonist,
• 8:55
  it
• 8:55
  doesn't
• 8:56
  negotiate.
• 8:56
  It
• 8:56
  just
• 8:57
  shuts
• 8:57
  everything
• 8:57
  down
• 8:58
  quickly,
• 8:59
  okay?
• 9:00
  And
• 9:00
  again,
• 9:00
  a
• 9:00
  very
• 9:01
  high
• 9:01
  affinity.
• 9:02
  And
• 9:02
  Seroquel's
• 9:03
  kind
• 9:03
  of
• 9:03
  weak
• 9:03
  at
• 9:04
  that
• 9:04
  receptor.
• 9:04
  And
• 9:05
  again,
• 9:05
  you're
• 9:05
  going
• 9:05
  to
• 9:05
  need
• 9:06
  a
• 9:06
  lot
• 9:06
  of
• 9:06
  them
• 9:06
  because
• 9:06
  it's
• 9:07
  kind
• 9:07
  of
• 9:07
  scrawny.
• 9:08
  And
• 9:08
  the
• 9:08
  party's
• 9:08
  still
• 9:09
  going
• 9:09
  to
• 9:09
  be
• 9:09
  going
• 9:10
  on
• 9:10
  pretty,
• 9:10
  pretty
• 9:11
  strong.
• 9:11
  What
• 9:11
  makes
• 9:12
  this
• 9:12
  kind
• 9:12
  of
• 9:12
  interesting,
• 9:13
  my
• 9:13
  friends,
• 9:13
  is
• 9:13
  when
• 9:13
  we
• 9:14
  talk
• 9:14
  about
• 9:14
  Abilify,
• 9:15
  okay,
• 9:15
  Because
• 9:15
  Abilify
• 9:16
  is
• 9:16
  a.
• 9:17
  Is
• 9:17
  a
• 9:18
  partial
• 9:18
  agonist,
• 9:19
  okay?
• 9:20
  So
• 9:20
  we
• 9:20
  can
• 9:20
  almost
• 9:21
  think
• 9:21
  of
• 9:21
  Abilify
• 9:22
  a
• 9:23
  little
• 9:23
  bit.
• 9:23
  Like,
• 9:24
  let's
• 9:24
  say
• 9:25
  it's.
• 9:25
  It's.
• 9:26
  It's
• 9:26
  kind
• 9:26
  of
• 9:26
  like.
• 9:26
  Like
• 9:27
  a
• 9:27
  jazz
• 9:27
  band.
• 9:28
  Abilify
• 9:28
  kind
• 9:28
  of
• 9:29
  walks
• 9:29
  in
• 9:29
  there
• 9:30
  and
• 9:30
  instead
• 9:30
  of
• 9:31
  shutting
• 9:31
  the
• 9:31
  whole
• 9:31
  party
• 9:31
  down
• 9:32
  and
• 9:33
  everyone's
• 9:34
  just
• 9:34
  pissed
• 9:34
  off
• 9:35
  because
• 9:35
  it's.
• 9:36
  It's
• 9:37
  so
• 9:37
  stiff
• 9:38
  and.
• 9:38
  And
• 9:39
  there's
• 9:39
  no
• 9:39
  music
• 9:39
  anymore,
• 9:40
  no
• 9:40
  dancing
• 9:40
  anymore.
• 9:41
  Abilify
• 9:42
  kind
• 9:43
  of
• 9:43
  sets
• 9:43
  up
• 9:43
  instruments
• 9:44
  and
• 9:44
  plays
• 9:45
  smooth
• 9:45
  jazz
• 9:46
  throughout
• 9:46
  the
• 9:47
  entire
• 9:47
  nightclub,
• 9:48
  right?
• 9:48
  So
• 9:48
  it
• 9:48
  has
• 9:49
  a
• 9:49
  very
• 9:49
  high
• 9:49
  affinity
• 9:50
  for
• 9:50
  D2,
• 9:51
  which
• 9:51
  is
• 9:51
  very
• 9:52
  interesting.
• 9:53
  And
• 9:53
  it
• 9:53
  has
• 9:54
  a
• 9:54
  very
• 9:54
  high
• 9:55
  occupancy.
• 9:55
  It
• 9:56
  overtakes
• 9:56
  almost
• 9:57
  all
• 9:57
  the
• 9:57
  tables,
• 9:58
  like
• 9:58
  90
• 9:58
  some
• 9:58
  percent
• 9:59
  of
• 9:59
  the
• 9:59
  tables.
• 10:00
  But
• 10:00
  this
• 10:00
  is
• 10:00
  where
• 10:00
  intrinsic
• 10:01
  activity
• 10:01
  is
• 10:01
  so
• 10:02
  important,
• 10:02
  my
• 10:02
  friends,
• 10:03
  because
• 10:04
  it's
• 10:04
  not
• 10:04
  just
• 10:05
  about
• 10:05
  how
• 10:05
  many
• 10:05
  tables
• 10:06
  in
• 10:06
  the
• 10:06
  club
• 10:06
  you
• 10:06
  occupy,
• 10:07
  right?
• 10:08
  It's
• 10:08
  about
• 10:08
  what
• 10:09
  you
• 10:09
  do
• 10:09
  when
• 10:09
  you're
• 10:10
  occupying
• 10:10
  those
• 10:10
  tables,
• 10:11
  okay?
• 10:12
  That's
• 10:12
  really
• 10:12
  the
• 10:13
  key.
• 10:13
  So
• 10:13
  you
• 10:13
  could.
• 10:13
  You
• 10:14
  could
• 10:14
  look
• 10:14
  at
• 10:14
  Abilify
• 10:15
  and
• 10:15
  go,
• 10:15
  oh,
• 10:15
  my
• 10:15
  God,
• 10:15
  abilify
• 10:16
  is
• 10:16
  occupying
• 10:16
  90
• 10:17
  of
• 10:17
  the
• 10:17
  hundred
• 10:17
  tables.
• 10:18
  It
• 10:18
  really
• 10:18
  is
• 10:18
  shutting
• 10:19
  the
• 10:19
  party
• 10:19
  down.
• 10:20
  Well,
• 10:20
  no,
• 10:20
  because
• 10:20
  it's
• 10:21
  a
• 10:21
  partial
• 10:21
  agonist.
• 11:17
  So
• 11:17
  its
• 11:17
  job
• 11:17
  is
• 11:18
  actually,
• 11:19
  if
• 11:19
  the
• 11:19
  signal
• 11:19
  is
• 11:20
  too
• 11:20
  wild
• 11:21
  and
• 10:26
  crazy,
• 11:21
  it
• 11:22
  kind
• 11:22
  of
• 11:23
  lowers
• 11:23
  it
• 11:23
  a
• 11:23
  little
• 11:23
  bit.
• 11:24
  And
• 11:24
  if
• 11:24
  the
• 11:24
  signal
• 11:25
  is
• 11:25
  dead,
• 11:25
  it
• 11:25
  raises
• 11:26
  it
• 11:26
  a
• 11:26
  little
• 11:26
  bit,
• 11:26
  right?
• 11:27
  That's
• 11:27
  when
• 11:27
  you
• 11:27
  see
• 11:28
  in
• 11:28
  psychosis,
• 11:29
  in
• 11:29
  the
• 11:29
  mesolimbic
• 11:30
  path,
• 11:31
  brain
• 11:31
  pathways
• 11:32
  with
• 11:32
  hallucinations.
• 11:33
  Abilify
• 11:33
  kind
• 11:34
  of
• 11:34
  cools
• 11:34
  that
• 11:34
  down
• 11:35
  a
• 11:35
  little
• 11:35
  bit
• 11:35
  at
• 11:35
  the
• 11:35
  right
• 11:36
  dose,
• 11:36
  right?
• 11:36
  It'll
• 11:36
  cool
• 11:37
  that
• 11:37
  down.
• 11:37
  So
• 11:37
  you're
• 11:37
  not
• 11:37
  a
• 11:38
  psychotic,
• 11:38
  okay?
• 11:39
  But
• 11:39
  in
• 11:40
  the
• 11:40
  mesocortical
• 11:41
  regions
• 11:41
  of
• 11:41
  the
• 11:41
  brain,
• 11:42
  when
• 11:42
  there
• 11:42
  is
• 11:43
  a
• 11:43
  lack
• 11:43
  of.
• 11:43
  When
• 11:44
  it's
• 11:44
  harder
• 11:44
  to
• 11:44
  think
• 11:45
  and
• 11:45
  there's
• 11:45
  less
• 11:46
  motivation
• 11:47
  and
• 11:47
  energy,
• 11:47
  maybe
• 11:48
  a
• 11:48
  little
• 11:48
  bit
• 11:48
  of
• 11:48
  a
• 11:49
  dopamine
• 11:49
  burst
• 11:49
  there.
• 11:50
  Abilify
• 11:51
  kind
• 11:51
  of
• 11:51
  turns
• 11:51
  that
• 11:52
  up
• 11:52
  a
• 11:52
  little
• 11:52
  bit,
• 11:52
  right?
• 11:52
  So
• 11:53
  it's
• 11:53
  a
• 11:53
  partial
• 11:53
  agonist,
• 11:54
  like
• 11:54
  a
• 11:54
  dimmer
• 11:54
  switch.
• 11:55
  So
• 11:55
  Abilify
• 11:55
  is
• 11:56
  walking
• 11:56
  into
• 11:56
  this
• 11:56
  club,
• 11:57
  and
• 11:57
  it's
• 11:57
  a
• 11:57
  jazz
• 11:58
  band.
• 11:58
  It's
• 11:58
  not
• 11:58
  a
• 11:58
  bouncer
• 11:59
  like
• 11:59
  Haldol
• 12:00
  that's
• 12:00
  going
• 12:00
  to
• 12:00
  throw
• 12:00
  everyone
• 12:00
  out
• 12:01
  and
• 12:01
  kill
• 12:01
  the
• 12:01
  party
• 12:01
  and
• 12:02
  make
• 12:02
  it
• 12:02
  too
• 12:02
  stiff.
• 12:03
  Abili
• 12:03
  is
• 12:03
  like
• 12:04
  a
• 12:04
  smooth
• 12:04
  jazz
• 12:04
  band.
• 12:05
  It's
• 12:05
  taking
• 12:05
  up
• 12:05
  almost
• 12:06
  all
• 12:06
  the
• 12:06
  seats.
• 12:07
  And,
• 12:08
  you
• 12:08
  know,
• 12:08
  the
• 12:08
  room
• 12:09
  is
• 12:09
  not
• 12:09
  wild
• 12:10
  and
• 12:10
  thrashing
• 12:10
  anymore.
• 12:10
  It's
• 12:11
  kind
• 12:11
  of
• 12:11
  smooth
• 12:11
  and
• 12:12
  jazzy.
• 12:12
  The
• 12:12
  vibe
• 12:13
  calms
• 12:13
  down,
• 12:13
  the
• 12:13
  psychosis
• 12:14
  stops.
• 12:15
  Right?
• 12:15
  And
• 12:16
  that's
• 12:16
  kind
• 12:16
  of
• 12:16
  good,
• 12:17
  right?
• 12:17
  If
• 12:17
  you
• 12:17
  can
• 12:17
  imagine
• 12:18
  depression,
• 12:18
  like
• 12:19
  a
• 12:19
  nightclub
• 12:19
  that
• 12:20
  hasn't
• 12:20
  even
• 12:20
  opened
• 12:20
  yet.
• 12:21
  It's,
• 12:21
  like,
• 12:21
  kind
• 12:21
  of
• 12:21
  dead.
• 12:22
  There's
• 12:22
  just
• 12:22
  no
• 12:23
  vibe
• 12:23
  at
• 12:23
  all.
• 12:23
  Maybe
• 12:24
  the
• 12:24
  housekeepers
• 12:25
  are
• 12:25
  mopping
• 12:25
  around
• 12:26
  and
• 12:27
  it's
• 12:27
  just.
• 12:27
  There's
• 12:28
  like,
• 12:28
  no
• 12:28
  real
• 12:28
  party
• 12:29
  yet.
• 12:29
  Nobody's
• 12:29
  poured
• 12:30
  alcohol.
• 12:31
  Nobody's
• 12:31
  even
• 12:31
  started
• 12:32
  the
• 12:32
  grill.
• 12:32
  It's
• 12:33
  just
• 12:33
  kind
• 12:33
  of.
• 12:33
  Just
• 12:34
  not.
• 12:34
  There's
• 12:34
  not
• 12:35
  much
• 12:35
  going
• 12:35
  on.
• 12:35
  You
• 12:36
  can
• 12:36
  imagine
• 12:36
  Abilify
• 12:37
  coming
• 12:37
  in
• 12:37
  there
• 12:37
  as
• 12:38
  like
• 12:38
  a
• 12:38
  smooth
• 12:38
  jazz
• 12:39
  band
• 12:39
  warming
• 12:39
  up,
• 12:40
  creating
• 12:40
  a
• 12:40
  little
• 12:41
  bit
• 12:41
  of
• 12:41
  a
• 12:41
  vibe,
• 12:42
  maybe
• 12:42
  getting
• 12:42
  the
• 12:42
  beer
• 12:43
  taps
• 12:43
  on,
• 12:44
  right?
• 12:45
  So
• 12:45
  things
• 12:45
  are
• 12:45
  starting
• 12:45
  to
• 12:46
  happen
• 12:46
  because,
• 12:47
  again,
• 12:47
  Abilify
• 12:48
  is
• 12:48
  kind
• 12:48
  of
• 12:49
  that
• 12:49
  magic
• 12:49
  dial
• 12:49
  where
• 12:50
  if
• 12:50
  it's
• 12:50
  too
• 12:50
  crazy,
• 12:52
  you
• 12:52
  know,
• 12:52
  tampers
• 12:53
  things
• 12:53
  down
• 12:53
  a
• 12:53
  bit.
• 12:54
  But
• 12:54
  if
• 12:54
  it's
• 12:54
  too
• 12:55
  dead
• 12:55
  or
• 12:55
  empty,
• 12:56
  it
• 12:56
  kind
• 12:56
  of
• 12:56
  raises
• 12:57
  the
• 12:57
  stakes.
• 12:57
  I
• 12:57
  think
• 12:58
  that's
• 12:58
  a
• 12:58
  really
• 12:58
  cool
• 12:59
  mechanism
• 12:59
  of
• 13:00
  Abilify,
• 13:00
  really
• 13:00
  hedges
• 13:01
  you
• 13:02
  in
• 13:02
  clinic
• 13:02
  too,
• 13:02
  in
• 13:03
  my
• 13:03
  experience,
• 13:03
  you
• 13:04
  know,
• 13:04
  if
• 13:04
  you're
• 13:05
  not
• 13:05
  really
• 13:05
  sure
• 13:05
  what
• 13:05
  you're
• 13:05
  looking
• 13:06
  at
• 13:06
  or
• 13:06
  you're
• 13:07
  worried
• 13:07
  about
• 13:07
  overcorrecting
• 13:08
  or
• 13:08
  under
• 13:08
  correcting.
• 13:09
  Abilify
• 13:09
  has
• 13:10
  that
• 13:10
  built
• 13:10
  in
• 13:10
  mechanism,
• 13:11
  that
• 13:11
  partial
• 13:11
  agonism
• 13:12
  where
• 13:13
  you
• 13:13
  can
• 13:13
  kind
• 13:13
  of
• 13:14
  calm
• 13:14
  the
• 13:14
  storm,
• 13:15
  but
• 13:16
  you
• 13:16
  can
• 13:16
  also
• 13:16
  raise
• 13:17
  some
• 13:17
  of
• 13:17
  the
• 13:18
  activity
• 13:18
  in
• 13:18
  needed
• 13:19
  regions
• 13:19
  too,
• 13:20
  right.
• 13:20
  It's
• 13:21
  not
• 13:21
  as
• 13:21
  much
• 13:21
  of
• 13:21
  a
• 13:21
  weight
• 13:21
  gainer
• 13:22
  as
• 13:22
  the
• 13:23
  other,
• 13:23
  as,
• 13:24
  as
• 13:24
  the
• 13:24
  other
• 13:24
  agents
• 13:25
  like
• 13:25
  Zyprexa
• 13:26
  or
• 13:26
  Seroquel.
• 13:27
  We've
• 13:27
  talked
• 13:27
  about
• 13:27
  how
• 13:27
  it
• 13:27
  doesn't
• 13:28
  antagonize
• 13:28
  5ht2c
• 13:29
  as
• 13:30
  aggressively.
• 13:30
  The
• 13:31
  affinity
• 13:31
  is
• 13:31
  not
• 13:31
  as
• 13:32
  strong
• 13:32
  for
• 13:33
  5ht2c
• 13:34
  as
• 13:34
  it
• 13:34
  is
• 13:34
  in,
• 13:34
  like
• 13:35
  Seroquel
• 13:35
  or
• 13:36
  Zyprex.
• 13:36
  Abilify
• 13:37
  is
• 13:37
  not
• 13:37
  as
• 13:37
  aggressive.
• 13:38
  It's
• 13:38
  kind
• 13:38
  of
• 13:38
  like
• 13:38
  Gidon
• 13:39
  or
• 13:39
  the
• 13:39
  Tuda.
• 13:40
  It's
• 13:40
  a
• 13:40
  little
• 13:40
  nicer
• 13:41
  on
• 13:41
  the
• 13:41
  weight
• 13:41
  gain
• 13:42
  if
• 13:42
  you're,
• 13:42
  if
• 13:42
  you're
• 13:43
  trying
• 13:43
  to
• 13:43
  find
• 13:43
  somebody
• 13:43
  who's
• 13:44
  more
• 13:44
  concerned
• 13:45
  about
• 13:45
  that,
• 13:45
  right.
• 13:46
  As
• 13:46
  opposed
• 13:46
  to
• 13:46
  Zyprexa,
• 13:47
  which
• 13:48
  is
• 13:48
  going
• 13:48
  to
• 13:48
  walk
• 13:48
  in
• 13:48
  there,
• 13:49
  shut
• 13:49
  the
• 13:49
  party
• 13:49
  down
• 13:50
  and
• 13:51
  like
• 13:51
  give
• 13:51
  everyone
• 13:51
  a
• 13:52
  Big
• 13:52
  Mac
• 13:52
  and
• 13:52
  be
• 13:52
  like,
• 13:53
  hey,
• 13:53
  no
• 13:53
  more
• 13:53
  dancing,
• 13:54
  but
• 13:54
  just
• 13:54
  eat
• 13:54
  this
• 13:55
  Big
• 13:55
  Mac,
• 13:55
  you
• 13:56
  know,
• 13:56
  but
• 13:56
  you
• 13:56
  know,
• 13:57
  and
• 13:57
  think
• 13:57
  about
• 13:57
  it
• 13:58
  this
• 13:58
  way.
• 13:58
  If
• 13:58
  you're
• 13:58
  psychotic,
• 13:59
  it's,
• 13:59
  it's.
• 13:59
  You
• 14:00
  also
• 14:00
  don't
• 14:00
  want
• 14:00
  all
• 14:00
  that
• 14:01
  chaos,
• 14:01
  right?
• 14:01
  So
• 14:01
  Zyprexa
• 14:02
  is
• 14:02
  fantastic
• 14:02
  in
• 14:03
  a
• 14:03
  sense,
• 14:03
  right?
• 14:04
  Because
• 14:04
  if
• 14:04
  the
• 14:04
  party's
• 14:04
  getting
• 14:05
  dangerous
• 14:05
  and
• 14:05
  people
• 14:05
  are
• 14:06
  pushing
• 14:06
  and
• 14:06
  shoving
• 14:06
  each
• 14:07
  other
• 14:07
  and
• 14:07
  breaking
• 14:07
  glass,
• 14:08
  you
• 14:08
  want
• 14:09
  those
• 14:09
  bouncers
• 14:09
  to
• 14:10
  come
• 14:10
  in
• 14:10
  and
• 14:10
  restore
• 14:11
  order
• 14:11
  a
• 14:11
  little
• 14:11
  bit.
• 14:12
  And
• 14:12
  if
• 14:12
  you
• 14:13
  don't
• 14:13
  send
• 14:13
  too
• 14:14
  many
• 14:14
  of
• 14:14
  them,
• 14:14
  you
• 14:14
  just
• 14:14
  send
• 14:15
  the
• 14:15
  right
• 14:15
  amount,
• 14:15
  you
• 14:15
  don't
• 14:16
  occupy
• 14:17
  as
• 14:17
  many
• 14:17
  of
• 14:17
  the
• 14:18
  receptors.
• 14:18
  So
• 14:18
  in
• 14:19
  other
• 14:19
  words,
• 14:19
  you
• 14:19
  don't
• 14:19
  increase
• 14:19
  the
• 14:20
  dose,
• 14:20
  you
• 14:20
  know,
• 14:21
  beyond
• 14:22
  what's
• 14:22
  therapeutic,
• 14:23
  then
• 14:23
  sure,
• 14:23
  the
• 14:23
  party
• 14:23
  can
• 14:24
  have
• 14:24
  a
• 14:24
  semblance
• 14:24
  of
• 14:25
  order
• 14:25
  and
• 14:26
  it
• 14:26
  can
• 14:26
  be,
• 14:26
  can
• 14:27
  be
• 14:27
  very
• 14:27
  pleasant,
• 14:27
  actually.
• 14:28
  Remember,
• 14:28
  we're
• 14:29
  only
• 14:29
  talking
• 14:29
  about
• 14:29
  D2
• 14:30
  receptors
• 14:30
  in
• 14:31
  this
• 14:31
  analogy.
• 14:31
  Think
• 14:32
  of
• 14:32
  all
• 14:32
  the
• 14:32
  other
• 14:32
  receptors.
• 14:33
  1A,
• 14:35
  right.
• 14:35
  2A,
• 14:36
  of
• 14:36
  course.
• 14:36
  And
• 14:37
  when
• 14:37
  you
• 14:37
  antagonize,
• 14:37
  it
• 14:38
  kind
• 14:38
  of
• 14:38
  mitigates
• 14:39
  the
• 14:39
  motor
• 14:39
  side
• 14:39
  effects.
• 14:40
  So
• 14:40
  this
• 14:40
  nightclub
• 14:41
  analogy
• 14:42
  can
• 14:42
  actually
• 14:42
  get
• 14:42
  way
• 14:42
  more
• 14:43
  colorful
• 14:43
  and
• 14:43
  interesting
• 14:44
  depending
• 14:45
  on
• 14:45
  what
• 14:46
  the
• 14:46
  other
• 14:46
  tables
• 14:46
  are
• 14:46
  doing.
• 14:47
  Right?
• 14:47
  Because
• 14:47
  you
• 14:47
  could
• 14:48
  have
• 14:48
  some
• 14:48
  people
• 14:49
  go
• 14:49
  in
• 14:49
  there
• 14:49
  and
• 14:50
  go
• 14:50
  to
• 14:50
  different
• 14:50
  tables
• 14:51
  and
• 14:51
  make
• 14:51
  the
• 14:51
  vibe
• 14:51
  a
• 14:52
  lot
• 14:52
  more
• 14:52
  relaxed,
• 14:53
  right?
• 14:53
  You
• 14:53
  could
• 14:53
  have
• 14:53
  like
• 14:54
  a
• 14:54
  eucalyptus
• 14:55
  diffuser
• 14:55
  or
• 14:55
  something
• 14:56
  for
• 14:56
  5
• 14:56
  1A,
• 14:57
  where
• 14:58
  some
• 14:58
  of
• 14:58
  these
• 14:58
  medications
• 14:59
  will
• 14:59
  actually
• 14:59
  make
• 14:59
  people
• 15:00
  feel
• 15:00
  a
• 15:00
  lot
• 15:00
  calmer.
• 15:01
  The
• 15:02
  smell
• 15:02
  will
• 15:02
  be
• 15:03
  more
• 15:03
  calming,
• 15:04
  Right.
• 15:04
  In
• 15:04
  addition
• 15:05
  to
• 15:05
  the
• 15:05
  party
• 15:06
  getting
• 15:06
  less
• 15:06
  chaotic
• 15:07
  and
• 15:07
  thrashy
• 15:08
  and
• 15:08
  wild.
• 15:09
  So
• 15:09
  remember,
• 15:10
  your
• 15:10
  medications
• 15:10
  don't
• 15:11
  just
• 15:11
  do
• 15:11
  one
• 15:11
  thing.
• 15:12
  There
• 15:12
  are
• 15:12
  many
• 15:13
  different
• 15:13
  tables,
• 15:14
  so
• 15:14
  to
• 15:14
  speak,
• 15:14
  at
• 15:15
  the
• 15:15
  nightclub,
• 15:16
  which.
• 15:16
  And
• 15:16
  they're
• 15:16
  each
• 15:17
  kind
• 15:17
  of
• 15:17
  behaving
• 15:17
  in
• 15:18
  a
• 15:18
  certain
• 15:18
  way,
• 15:18
  and
• 15:18
  they
• 15:18
  can
• 15:18
  do
• 15:19
  certain
• 15:19
  things,
• 15:20
  and
• 15:20
  you
• 15:20
  have
• 15:20
  to
• 15:20
  occupy
• 15:21
  enough
• 15:21
  of
• 15:22
  them
• 15:22
  often
• 15:22
  enough.
• 15:23
  But
• 15:23
  it's
• 15:23
  not
• 15:23
  just
• 15:24
  about
• 15:24
  occupying
• 15:24
  those
• 15:25
  tables,
• 15:25
  all
• 15:25
  right?
• 15:25
  It's
• 15:25
  not
• 15:26
  about
• 15:26
  the
• 15:26
  total
• 15:26
  receptors
• 15:27
  that
• 15:27
  are
• 15:27
  bound
• 15:28
  by
• 15:28
  a
• 15:28
  drug
• 15:28
  at
• 15:28
  a
• 15:28
  given
• 15:29
  concentration,
• 15:30
  but
• 15:30
  it's
• 15:30
  also
• 15:30
  about
• 15:31
  what
• 15:31
  that
• 15:31
  drug
• 15:31
  is
• 15:32
  doing
• 15:32
  at
• 15:32
  the
• 15:33
  receptor.
• 15:33
  Right?
• 15:34
  Just
• 15:34
  sending
• 15:34
  someone
• 15:35
  to
• 15:35
  a
• 15:35
  VIP
• 15:35
  table
• 15:36
  is
• 15:36
  not
• 15:36
  enough
• 15:36
  to
• 15:36
  know
• 15:37
  what
• 15:37
  the
• 15:37
  medication
• 15:38
  is
• 15:38
  going
• 15:38
  to
• 15:38
  do.
• 15:38
  It's,
• 15:38
  well,
• 15:39
  what
• 15:39
  are
• 15:39
  you
• 15:39
  going
• 15:39
  to
• 15:39
  do
• 15:39
  when
• 15:39
  you're
• 15:40
  at
• 15:40
  that
• 15:40
  table?
• 15:41
  And
• 15:41
  like
• 15:41
  I
• 15:41
  said,
• 15:42
  Abilify
• 15:42
  is
• 15:43
  going
• 15:43
  to
• 15:43
  saturate
• 15:44
  these
• 15:44
  tables.
• 15:45
  So
• 15:45
  you'd
• 15:45
  almost
• 15:45
  say,
• 15:45
  oh,
• 15:46
  my
• 15:46
  God.
• 15:46
  Well,
• 15:47
  don't
• 15:47
  shut
• 15:47
  the
• 15:47
  whole
• 15:47
  party
• 15:47
  down.
• 15:48
  Well,
• 15:48
  wait
• 15:48
  a
• 15:48
  minute.
• 15:48
  That's
• 15:48
  not
• 15:48
  what
• 15:49
  Abilify
• 15:49
  does.
• 15:50
  It's
• 15:50
  the
• 15:50
  smooth
• 15:51
  jazz
• 15:51
  band.
• 15:51
  It's
• 15:52
  not
• 15:52
  Hallol.
• 15:52
  It's
• 15:52
  not
• 15:52
  the
• 15:53
  aggressive
• 15:53
  bouncer,
• 15:54
  Right?
• 15:55
  And
• 15:55
  we
• 15:55
  could
• 15:56
  go
• 15:56
  on
• 15:56
  and
• 15:56
  on
• 15:56
  about
• 15:56
  these
• 15:57
  analogies.
• 15:57
  I
• 15:58
  found
• 15:58
  that
• 15:58
  the
• 15:58
  D2
• 15:59
  receptor
• 16:00
  is
• 16:00
  a
• 16:00
  really
• 16:00
  fun
• 16:01
  one
• 16:01
  to
• 16:01
  talk
• 16:01
  about
• 16:02
  because
• 16:02
  I
• 16:03
  think
• 16:03
  it
• 16:03
  just.
• 16:03
  It
• 16:03
  makes
• 16:03
  this
• 16:04
  analogy
• 16:04
  click
• 16:04
  a
• 16:05
  lot
• 16:05
  easier
• 16:06
  just.
• 16:06
  Just
• 16:06
  given
• 16:07
  the
• 16:07
  fact
• 16:07
  that
• 16:07
  you
• 16:07
  can
• 16:07
  overdo
• 16:08
  it
• 16:08
  and
• 16:08
  cause
• 16:08
  side
• 16:08
  effects.
• 16:09
  You
• 16:09
  can
• 16:09
  keep
• 16:09
  it
• 16:09
  just
• 16:10
  right
• 16:10
  and
• 16:10
  stem
• 16:10
  the
• 16:11
  chaos.
• 16:12
  But.
• 16:12
  But
• 16:12
  then,
• 16:12
  of
• 16:12
  course,
• 16:13
  you
• 16:13
  can.
• 16:14
  You
• 16:14
  cannot
• 16:14
  do
• 16:14
  enough,
• 16:14
  right?
• 16:15
  You
• 16:15
  could
• 16:15
  not
• 16:16
  block
• 16:16
  enough
• 16:16
  receptors.
• 16:17
  And
• 16:17
  the
• 16:17
  party's
• 16:17
  still
• 16:18
  wild,
• 16:18
  right?
• 16:18
  If
• 16:18
  you
• 16:18
  underdose
• 16:19
  a
• 16:19
  patient,
• 16:19
  you
• 16:19
  give
• 16:20
  them
• 16:20
  like
• 16:20
  half
• 16:20
  a
• 16:20
  milligram
• 16:21
  of
• 16:21
  risperidol,
• 16:21
  expecting
• 16:22
  some
• 16:22
  psychosis
• 16:23
  to
• 16:23
  go
• 16:23
  away.
• 16:23
  Well,
• 16:24
  it
• 16:24
  probably
• 16:24
  won't
• 16:24
  at
• 16:24
  5.5
• 16:25
  milligrams
• 16:26
  with,
• 16:26
  like
• 16:26
  a.
• 16:26
  An
• 16:26
  adult.
• 16:27
  And
• 16:27
  of
• 16:28
  course,
• 16:28
  let's
• 16:28
  not
• 16:28
  forget
• 16:28
  the
• 16:29
  full
• 16:29
  agonist,
• 16:29
  my
• 16:30
  friend.
• 16:30
  So
• 16:30
  when
• 16:30
  we
• 16:30
  talk
• 16:30
  about
• 16:31
  intrinsic
• 16:31
  activity
• 16:32
  or
• 16:32
  what
• 16:33
  really
• 16:33
  happens
• 16:33
  at
• 16:33
  the
• 16:34
  drug
• 16:34
  receptor
• 16:34
  complex,
• 16:35
  right?
• 16:35
  What
• 16:35
  biological
• 16:36
  response
• 16:36
  is
• 16:37
  happening
• 16:37
  once
• 16:38
  the
• 16:38
  drug
• 16:38
  is
• 16:38
  bound?
• 16:39
  Heroin
• 16:40
  is
• 16:40
  a
• 16:40
  full
• 16:40
  agonist.
• 16:40
  So
• 16:41
  that
• 16:41
  would
• 16:41
  be
• 16:41
  like,
• 16:42
  instead
• 16:42
  of
• 16:42
  sending
• 16:43
  a
• 16:43
  bouncer
• 16:43
  to
• 16:43
  shut
• 16:44
  the
• 16:44
  nightclub
• 16:44
  down,
• 16:45
  you're
• 16:45
  sending
• 16:46
  in
• 16:46
  like
• 16:46
  100
• 16:47
  more
• 16:47
  people
• 16:48
  who
• 16:48
  are
• 16:49
  extremely
• 16:50
  aggressive
• 16:51
  and
• 16:51
  high
• 16:52
  and
• 16:52
  ready
• 16:52
  to
• 16:53
  party,
• 16:53
  right?
• 16:53
  So
• 16:53
  it's
• 16:54
  like
• 16:54
  full
• 16:54
  spectrum.
• 16:55
  That
• 16:55
  nightclub's
• 16:55
  about
• 16:55
  to
• 16:56
  get
• 16:56
  way
• 16:56
  more
• 16:56
  intense.
• 16:57
  That's
• 16:57
  the
• 16:57
  full
• 16:57
  agonism,
• 16:58
  right?
• 16:58
  What
• 16:59
  medication
• 17:00
  am
• 17:00
  I
• 17:00
  about
• 17:00
  to
• 17:00
  prescribe,
• 17:01
  right?
• 17:01
  Is
• 17:01
  it
• 17:01
  going
• 17:02
  to
• 17:02
  make
• 17:02
  this
• 17:02
  party
• 17:02
  more
• 17:03
  intense
• 17:03
  to
• 17:03
  where
• 17:04
  this
• 17:04
  is
• 17:04
  untenable?
• 17:05
  Is
• 17:05
  it
• 17:05
  going
• 17:06
  to
• 17:06
  calm
• 17:06
  the
• 17:06
  party
• 17:06
  down?
• 17:06
  How
• 17:07
  much
• 17:07
  is
• 17:07
  it
• 17:07
  going
• 17:07
  to
• 17:07
  calm
• 17:08
  the
• 17:08
  party
• 17:08
  Down.
• 17:09
  How
• 17:09
  easy
• 17:09
  is
• 17:10
  it
• 17:10
  going
• 17:10
  to
• 17:10
  be
• 17:10
  for
• 17:10
  this
• 17:10
  medication
• 17:11
  to
• 17:11
  calm
• 17:11
  the
• 17:11
  party
• 17:12
  down?
• 17:12
  Right.
• 17:12
  Am
• 17:13
  I
• 17:13
  going
• 17:13
  to
• 17:13
  have
• 17:13
  to
• 17:13
  like
• 17:14
  send
• 17:14
  in
• 17:14
  bouncer
• 17:15
  after
• 17:15
  bouncer
• 17:15
  after
• 17:16
  bouncer
• 17:16
  like
• 17:16
  Seroquel?
• 17:17
  And
• 17:17
  how
• 17:18
  gentle
• 17:18
  is
• 17:18
  it?
• 17:18
  Right.
• 17:18
  Halenol
• 17:19
  is
• 17:19
  not
• 17:19
  that
• 17:20
  gentle
• 17:20
  at,
• 17:20
  at
• 17:20
  a
• 17:21
  certain
• 17:21
  point.
• 17:21
  Right.
• 17:21
  It
• 17:21
  can
• 17:22
  cause
• 17:22
  that
• 17:22
  stiffness,
• 17:22
  maybe
• 17:23
  Seroquel.
• 17:23
  Even
• 17:24
  though
• 17:24
  you
• 17:24
  have
• 17:24
  to
• 17:24
  send
• 17:24
  bouncer
• 17:25
  after
• 17:25
  bouncer
• 17:25
  after
• 17:26
  bouncer,
• 17:26
  it
• 17:27
  doesn't,
• 17:27
  you
• 17:27
  know,
• 17:27
  yank
• 17:28
  the,
• 17:29
  the
• 17:29
  guy
• 17:29
  by
• 17:29
  the
• 17:29
  collar
• 17:30
  off
• 17:30
  the
• 17:30
  table.
• 17:31
  It's
• 17:31
  kind
• 17:31
  of
• 17:31
  more
• 17:31
  gentle.
• 17:32
  Right.
• 17:32
  It
• 17:32
  has
• 17:32
  a
• 17:33
  different
• 17:33
  pharmacokinetic
• 17:34
  effect,
• 17:35
  but
• 17:35
  it
• 17:35
  is
• 17:35
  pretty
• 17:35
  neat
• 17:36
  how
• 17:36
  Seroquel
• 17:37
  kind
• 17:37
  of
• 17:37
  slides
• 17:38
  on
• 17:38
  and
• 17:38
  off
• 17:38
  the
• 17:38
  receptor
• 17:39
  rather
• 17:39
  than
• 17:39
  just
• 17:40
  grabbing
• 17:41
  its
• 17:41
  collar
• 17:42
  and
• 17:42
  not
• 17:42
  leaving.
• 17:42
  Right.
• 17:43
  There's
• 17:43
  a
• 17:43
  special
• 17:43
  term
• 17:44
  for
• 17:44
  that.
• 17:44
  I
• 17:44
  think
• 17:44
  it's
• 17:45
  like
• 17:45
  on
• 17:45
  and
• 17:45
  off
• 17:45
  pharmacokinetics
• 17:46
  or
• 17:46
  something
• 17:47
  of
• 17:47
  that
• 17:47
  nature
• 17:47
  where
• 17:48
  Seroquel
• 17:48
  doesn't
• 17:49
  bind
• 17:49
  as
• 17:49
  tightly.
• 17:50
  It
• 17:50
  kind
• 17:50
  of
• 17:50
  floats
• 17:51
  there
• 17:51
  so
• 17:51
  that
• 17:52
  your
• 17:52
  own
• 17:52
  endogenous
• 17:53
  dopamine
• 17:53
  can
• 17:53
  still
• 17:54
  hit
• 17:54
  the
• 17:54
  receptor.
• 17:55
  Thus,
• 17:55
  that's
• 17:55
  why
• 17:56
  it
• 17:56
  doesn't
• 17:56
  have
• 17:56
  as
• 17:56
  many
• 17:57
  wild
• 17:57
  side
• 17:57
  effects
• 17:58
  like
• 17:58
  the
• 17:58
  stiffness
• 17:59
  and
• 17:59
  rigidity.
• 18:00
  It's
• 18:00
  a
• 18:00
  little
• 18:00
  easier
• 18:01
  on
• 18:01
  your
• 18:01
  patients
• 18:02
  who
• 18:02
  are
• 18:02
  complaining
• 18:02
  of
• 18:02
  that
• 18:03
  stuff.
• 18:03
  So.
• 18:03
  But
• 18:04
  again,
• 18:04
  you
• 18:04
  need
• 18:04
  to
• 18:04
  send
• 18:05
  many
• 18:05
  of
• 18:05
  the
• 18:05
  bouncers.
• 18:06
  Can
• 18:06
  your
• 18:06
  patient
• 18:07
  tolerate
• 18:07
  all
• 18:08
  of
• 18:08
  those
• 18:09
  dose
• 18:10
  increases?
• 18:10
  Especially
• 18:10
  when
• 18:11
  it's
• 18:11
  also
• 18:11
  doing
• 18:12
  other
• 18:12
  things
• 18:13
  to
• 18:13
  the
• 18:13
  partygoers,
• 18:14
  Right.
• 18:14
  Seroquel
• 18:14
  makes
• 18:14
  you
• 18:15
  pretty
• 18:15
  sedated,
• 18:15
  right?
• 18:16
  So
• 18:16
  expanding
• 18:17
  the
• 18:17
  analogy,
• 18:18
  it's
• 18:18
  almost
• 18:19
  like
• 18:19
  Seroquel's
• 18:20
  coming
• 18:20
  in
• 18:20
  there
• 18:21
  to
• 18:21
  restore
• 18:21
  order,
• 18:22
  but
• 18:22
  it's
• 18:22
  almost
• 18:22
  making
• 18:23
  the
• 18:24
  partygoers
• 18:25
  fall
• 18:25
  asleep.
• 18:25
  It's
• 18:25
  like
• 18:26
  playing,
• 18:26
  you
• 18:27
  know,
• 18:27
  slow
• 18:28
  music,
• 18:28
  like,
• 18:29
  like,
• 18:29
  like
• 18:29
  what's
• 18:30
  an
• 18:30
  example
• 18:30
  of
• 18:30
  a,
• 18:30
  like
• 18:31
  a
• 18:31
  song
• 18:31
  that
• 18:31
  will
• 18:31
  put
• 18:32
  you
• 18:32
  to
• 18:32
  sleep?
• 18:33
  I
• 18:33
  don't
• 18:33
  know,
• 18:33
  like
• 18:34
  opera
• 18:34
  or,
• 18:35
  or
• 18:35
  something
• 18:35
  just
• 18:36
  like
• 18:36
  torturous,
• 18:37
  where,
• 18:38
  you
• 18:38
  know,
• 18:38
  now
• 18:38
  all
• 18:39
  the
• 18:39
  partygoers
• 18:39
  are
• 18:39
  like,
• 18:40
  they're,
• 18:40
  they're
• 18:40
  so
• 18:40
  sleepy
• 18:41
  they
• 18:41
  don't
• 18:41
  even
• 18:41
  want
• 18:42
  to
• 18:42
  party
• 18:42
  anymore.
• 18:43
  Right.
• 18:43
  It's
• 18:44
  okay,
• 18:44
  like
• 18:44
  maybe
• 18:44
  you.
• 18:45
  But,
• 18:45
  but
• 18:45
  like
• 18:45
  they're
• 18:45
  still
• 18:46
  hallucinating,
• 18:46
  right?
• 18:47
  Because
• 18:47
  you
• 18:47
  didn't
• 18:47
  send
• 18:47
  enough
• 18:47
  of
• 18:48
  the
• 18:48
  bouncers,
• 18:48
  right.
• 18:49
  So
• 18:49
  there's,
• 18:49
  there's
• 18:50
  all
• 18:50
  these
• 18:50
  elegant
• 18:50
  trade
• 18:51
  offs
• 18:51
  with
• 18:51
  all
• 18:51
  of
• 18:52
  these
• 18:52
  medications,
• 18:52
  but
• 18:53
  it
• 18:53
  really
• 18:53
  comes
• 18:53
  down
• 18:54
  to
• 18:54
  affinity,
• 18:54
  right?
• 18:55
  How
• 18:56
  attracted
• 18:57
  is
• 18:57
  this
• 18:57
  medication
• 18:58
  in
• 18:58
  my
• 18:58
  hands
• 18:58
  going
• 18:59
  to
• 18:59
  be
• 18:59
  to
• 18:59
  my
• 18:59
  targets,
• 19:00
  my
• 19:01
  receptor
• 19:01
  target
• 19:01
  that
• 19:02
  I
• 19:02
  need
• 19:02
  to
• 19:02
  target
• 19:02
  to
• 19:03
  make
• 19:03
  this
• 19:03
  patient,
• 19:03
  to
• 19:04
  make
• 19:04
  this
• 19:04
  patient's
• 19:04
  life
• 19:05
  a
• 19:05
  little
• 19:05
  smoother?
• 19:06
  So
• 19:06
  is
• 19:06
  this
• 19:06
  a
• 19:06
  drug
• 19:06
  that
• 19:07
  even
• 19:07
  has
• 19:07
  an
• 19:07
  affinity
• 19:08
  for
• 19:08
  a
• 19:08
  target
• 19:08
  receptor?
• 19:09
  In
• 19:09
  fact,
• 19:10
  let's
• 19:10
  back
• 19:10
  up
• 19:10
  a
• 19:10
  little
• 19:10
  bit
• 19:11
  and
• 19:11
  say,
• 19:11
  first
• 19:12
  identify
• 19:12
  the
• 19:13
  target
• 19:13
  receptor
• 19:13
  are
• 19:14
  we
• 19:14
  targeting
• 19:14
  D2?
• 19:15
  Are
• 19:15
  we
• 19:15
  targeting
• 19:15
  1A?
• 19:16
  You
• 19:16
  know,
• 19:17
  are
• 19:17
  we
• 19:17
  targeting
• 19:17
  5
• 19:18
  HT
• 19:18
  2C?
• 19:19
  Normally,
• 19:19
  when
• 19:19
  you
• 19:20
  activate
• 19:20
  that,
• 19:21
  it,
• 19:22
  you
• 19:22
  know,
• 19:22
  pumps
• 19:23
  the
• 19:23
  brakes
• 19:23
  on
• 19:23
  dopamine
• 19:24
  and
• 19:24
  norepinephrine
• 19:25
  in
• 19:25
  the
• 19:25
  prefrontal
• 19:25
  cortex.
• 19:26
  By
• 19:26
  antagonizing
• 19:27
  that,
• 19:27
  maybe.
• 19:28
  Is
• 19:28
  that
• 19:28
  our
• 19:28
  target?
• 19:28
  So
• 19:29
  we
• 19:29
  can
• 19:29
  bring
• 19:29
  a
• 19:30
  little
• 19:30
  more
• 19:30
  dopamine.
• 19:30
  Norepinephrine
• 19:31
  in
• 19:31
  the
• 19:31
  prefrontal
• 19:32
  cortex.
• 19:32
  Like,
• 19:33
  what's
• 19:33
  our
• 19:33
  target
• 19:33
  here,
• 19:34
  right?
• 19:34
  Is
• 19:34
  it
• 19:35
  histamine?
• 19:35
  Is
• 19:35
  it
• 19:36
  a
• 19:36
  melatonin
• 19:36
  agonism?
• 19:37
  Is
• 19:37
  that
• 19:37
  what
• 19:37
  we're
• 19:38
  doing?
• 19:38
  So
• 19:38
  find
• 19:38
  the
• 19:38
  target,
• 19:39
  right?
• 19:39
  When
• 19:40
  in
• 19:40
  front
• 19:40
  of
• 19:40
  the
• 19:40
  patient,
• 19:41
  find
• 19:41
  the
• 19:41
  medication
• 19:42
  that
• 19:42
  has
• 19:42
  a
• 19:43
  good
• 19:43
  affinity
• 19:43
  for
• 19:43
  the
• 19:43
  target.
• 19:44
  Figure
• 19:44
  out
• 19:45
  the
• 19:45
  occupancy
• 19:46
  percentage
• 19:47
  that
• 19:47
  typically
• 19:47
  is
• 19:47
  required
• 19:48
  to
• 19:49
  exert
• 19:49
  an
• 19:49
  effect
• 19:50
  and
• 19:50
  have
• 19:50
  an
• 19:51
  understanding
• 19:51
  of
• 19:51
  what.
• 19:51
  What
• 19:52
  the
• 19:52
  medication's
• 19:52
  even
• 19:53
  going
• 19:53
  to
• 19:53
  do
• 19:53
  when
• 19:53
  it
• 19:53
  gets
• 19:54
  there.
• 19:54
  And
• 19:54
  if
• 19:54
  you
• 19:55
  can
• 19:55
  conceptualize
• 19:55
  that
• 19:56
  in
• 19:56
  the
• 19:56
  form
• 19:56
  of
• 19:56
  a
• 19:56
  nightclub,
• 19:57
  I
• 19:57
  think
• 19:57
  that's
• 19:57
  a
• 19:57
  pretty
• 19:58
  cool
• 19:58
  way
• 19:58
  to
• 19:58
  do
• 19:58
  it.
• 19:59
  And
• 19:59
  it
• 19:59
  gives
• 19:59
  you
• 20:00
  an
• 20:00
  appreciation
• 20:00
  for
• 20:01
  what
• 20:01
  the
• 20:01
  heck
• 20:01
  we're
• 20:01
  even
• 20:01
  talking
• 20:02
  about
• 20:02
  and
• 20:02
  why.
• 20:03
  And
• 20:03
  one
• 20:03
  of
• 20:03
  the
• 20:04
  big
• 20:04
  takeaways,
• 20:04
  my
• 20:04
  friends,
• 20:05
  again,
• 20:05
  is
• 20:05
  don't
• 20:05
  forget
• 20:06
  that
• 20:06
  occupancy
• 20:07
  is
• 20:07
  not
• 20:07
  the
• 20:07
  whole
• 20:07
  story,
• 20:08
  right?
• 20:08
  Like
• 20:09
  Abilify,
• 20:09
  you
• 20:09
  can
• 20:09
  occupy
• 20:10
  every
• 20:11
  single
• 20:11
  seat
• 20:11
  in
• 20:11
  the
• 20:11
  nightclub,
• 20:12
  but
• 20:12
  it
• 20:12
  doesn't
• 20:13
  mean
• 20:13
  you're
• 20:14
  gonna
• 20:14
  shut
• 20:14
  the
• 20:14
  nightclub
• 20:15
  down
• 20:15
  or
• 20:16
  make
• 20:16
  the
• 20:16
  nightclub
• 20:16
  go
• 20:17
  berserko
• 20:17
  and
• 20:18
  party
• 20:18
  even
• 20:18
  harder.
• 20:19
  In
• 20:19
  fact,
• 20:19
  it's
• 20:20
  what
• 20:20
  the
• 20:21
  medication
• 20:22
  does
• 20:22
  at
• 20:22
  the
• 20:22
  receptor,
• 20:23
  hence
• 20:23
  the
• 20:23
  intrinsic
• 20:24
  activity,
• 20:25
  the
• 20:25
  efficacy,
• 20:26
  that
• 20:26
  matters.
• 20:27
  And
• 20:27
  Abilify
• 20:28
  is
• 20:28
  smooth
• 20:28
  jazz.
• 20:29
  It's
• 20:29
  a
• 20:29
  partial
• 20:29
  agonist.
• 20:30
  So
• 20:30
  you're
• 20:30
  in
• 20:30
  all
• 20:31
  the
• 20:31
  seats.
• 20:31
  That's
• 20:31
  great.
• 20:32
  And
• 20:32
  what
• 20:32
  are
• 20:32
  you
• 20:32
  doing
• 20:33
  when
• 20:33
  you're
• 20:33
  in
• 20:33
  all
• 20:33
  the
• 20:33
  seats?
• 20:33
  Well,
• 20:34
  you're
• 20:34
  kind
• 20:34
  of
• 20:34
  making
• 20:35
  the
• 20:35
  whole
• 20:35
  show
• 20:35
  a
• 20:35
  lot
• 20:36
  smoother.
• 20:36
  This
• 20:36
  is
• 20:37
  less
• 20:37
  of
• 20:37
  a
• 20:37
  rave
• 20:37
  now
• 20:38
  and
• 20:38
  more
• 20:38
  of
• 20:38
  a
• 20:38
  jazz
• 20:39
  fest.
• 20:40
  Anyway,
• 20:40
  I
• 20:40
  hope
• 20:40
  you
• 20:40
  all
• 20:41
  really
• 20:41
  enjoyed
• 20:42
  this
• 20:42
  one.
• 20:42
  I
• 20:42
  know
• 20:42
  I
• 20:42
  did
• 20:43
  kind
• 20:43
  of
• 20:43
  weaving
• 20:44
  all
• 20:44
  of
• 20:44
  these
• 20:44
  together.
• 20:45
  Now,
• 20:45
  folks,
• 20:46
  if
• 20:46
  you
• 20:47
  really
• 20:47
  want
• 20:47
  to
• 20:47
  stand
• 20:48
  out
• 20:48
  as
• 20:48
  a
• 20:48
  clinician
• 20:49
  and
• 20:49
  feel
• 20:49
  confident
• 20:49
  on
• 20:50
  the
• 20:50
  details
• 20:51
  without
• 20:51
  getting
• 20:51
  stuck,
• 20:52
  when
• 20:52
  you're
• 20:52
  finally
• 20:52
  in
• 20:53
  front
• 20:53
  of
• 20:53
  a
• 20:53
  patient,
• 20:54
  the
• 20:54
  best
• 20:54
  thing
• 20:54
  you
• 20:54
  can
• 20:55
  do,
• 20:55
  my
• 20:55
  friends,
• 20:55
  is
• 20:55
  go
• 20:56
  into
• 20:56
  our
• 20:56
  show
• 20:56
  notes
• 20:57
  and
• 20:57
  become
• 20:57
  a
• 20:57
  Patreon
• 20:58
  member.
• 20:58
  That's
• 20:59
  where
• 20:59
  I
• 20:59
  keep
• 20:59
  the
• 21:00
  case
• 21:00
  breakdowns,
• 21:01
  med
• 21:01
  deep
• 21:02
  dives,
• 21:02
  and
• 21:02
  gritty
• 21:03
  weekly
• 21:03
  street
• 21:03
  pearls,
• 21:04
  all
• 21:04
  to
• 21:04
  keep
• 21:05
  you
• 21:05
  super
• 21:05
  organized
• 21:06
  so
• 21:06
  you
• 21:06
  can
• 21:06
  use
• 21:06
  this
• 21:06
  in
• 21:07
  front
• 21:07
  of
• 21:07
  a
• 21:07
  patient
• 21:08
  and
• 21:08
  really
• 21:08
  have
• 21:09
  that
• 21:09
  edge.
• 21:10
  Patreon
• 21:10
  membership
• 21:11
  is
• 21:11
  a
• 21:11
  steal.
• 21:12
  It's
• 21:12
  loaded
• 21:12
  with
• 21:12
  pearls
• 21:13
  that
• 21:13
  are
• 21:13
  going
• 21:13
  to
• 21:13
  just
• 21:14
  make
• 21:14
  your
• 21:14
  life
• 21:14
  easier,
• 21:15
  make
• 21:15
  your
• 21:15
  patients
• 21:16
  life
• 21:16
  easier,
• 21:17
  and
• 21:17
  for
• 21:17
  three
• 21:17
  bucks
• 21:18
  a
• 21:18
  month,
• 21:18
  for
• 21:18
  a
• 21:18
  lot
• 21:18
  of
• 21:18
  these
• 21:19
  memberships.
• 21:20
  It
• 21:20
  is
• 21:20
  just
• 21:21
  a
• 21:21
  steal.
• 21:21
  I
• 21:21
  wish
• 21:22
  I
• 21:22
  had
• 21:22
  it
• 21:22
  when
• 21:22
  I
• 21:22
  was
• 21:22
  in
• 21:23
  school.
• 21:23
  A
• 21:24
  collection
• 21:24
  of
• 21:24
  beautiful
• 21:25
  slide
• 21:25
  decks
• 21:25
  and
• 21:25
  just
• 21:26
  knowledge
• 21:26
  where
• 21:26
  you
• 21:26
  can
• 21:27
  nerd
• 21:27
  out.
• 21:27
  I
• 21:27
  was
• 21:27
  looking
• 21:28
  for
• 21:28
  that
• 21:28
  in
• 21:28
  school
• 21:29
  and
• 21:29
  I
• 21:29
  didn't
• 21:29
  have
• 21:29
  it.
• 21:29
  So
• 21:30
  I
• 21:30
  made
• 21:30
  it
• 21:30
  myself.
• 21:31
  And
• 21:31
  it's
• 21:31
  an
• 21:31
  ever
• 21:31
  growing
• 21:32
  library.
• 21:32
  It's
• 21:33
  updated
• 21:33
  every
• 21:33
  week.
• 21:34
  There's
• 21:34
  a
• 21:34
  community
• 21:34
  of
• 21:35
  Patreon
• 21:35
  members
• 21:36
  there.
• 21:36
  We're
• 21:36
  building
• 21:37
  a
• 21:37
  study
• 21:37
  hall.
• 21:37
  It's
• 21:38
  going
• 21:38
  to
• 21:38
  be
• 21:38
  awesome.
• 21:39
  Really
• 21:39
  excited.
• 21:40
  Encourage
• 21:40
  your
• 21:40
  friends
• 21:41
  to
• 21:41
  join
• 21:41
  and
• 21:41
  I
• 21:41
  will
• 21:42
  see
• 21:42
  you
• 21:42
  all
• 21:42
  next
• 21:42
  time
• 21:43
  here
• 21:43
  on
• 21:43
  Pearls
• 21:43
  and
• 21:44
  Prep.
• 21:44
  Sam.