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Transcript

Off the PHARM: Abilify Decoded: Insights into Its Unique Approach in Antipsychotic Therapy · Pearls and Prep

• 0:00
  Foreign.
• 0:06
  My
• 0:06
  friends,
• 0:07
  this
• 0:07
  is
• 0:07
  a
• 0:08
  bonus
• 0:09
  episode
• 0:09
  of
• 0:10
  our
• 0:10
  Pearls
• 0:11
  and
• 0:11
  Prep
• 0:11
  podcast
• 0:12
  where
• 0:12
  we
• 0:13
  take
• 0:13
  a
• 0:13
  deep
• 0:13
  dive
• 0:14
  into
• 0:14
  a
• 0:14
  single
• 0:14
  medication
• 0:15
  and
• 0:15
  unpack
• 0:16
  not
• 0:16
  just
• 0:16
  what
• 0:16
  it
• 0:16
  does,
• 0:17
  but
• 0:17
  how
• 0:18
  to
• 0:18
  actually
• 0:18
  think
• 0:19
  about
• 0:19
  using
• 0:19
  it.
• 0:20
  Today's
• 0:21
  spotlight
• 0:21
  is
• 0:22
  Abilify,
• 0:22
  also
• 0:23
  known
• 0:23
  as
• 0:23
  Aripiprazole.
• 0:25
  Now,
• 0:25
  Abilify
• 0:25
  is
• 0:26
  one
• 0:26
  of
• 0:26
  those
• 0:26
  meds
• 0:26
  you've
• 0:27
  probably
• 0:27
  heard
• 0:27
  about.
• 0:27
  It's
• 0:28
  on
• 0:28
  commercials,
• 0:28
  it's
• 0:29
  in
• 0:29
  every
• 0:29
  psych
• 0:29
  rotation,
• 0:30
  and
• 0:30
  it's
• 0:31
  on
• 0:31
  almost
• 0:31
  every
• 0:32
  board
• 0:32
  exam.
• 0:33
  But
• 0:33
  what
• 0:33
  makes
• 0:33
  it
• 0:34
  special
• 0:34
  is
• 0:35
  that
• 0:35
  it's
• 0:35
  not
• 0:35
  just
• 0:35
  another
• 0:36
  antipsychotic.
• 0:37
  It
• 0:38
  is
• 0:38
  what
• 0:38
  we
• 0:39
  call
• 0:39
  a
• 0:39
  dopamine
• 0:40
  serotonin
• 0:40
  system
• 0:41
  stabilizer,
• 0:42
  a
• 0:42
  second
• 0:43
  generation
• 0:43
  antipsychotic.
• 0:44
  A
• 0:44
  fancy
• 0:45
  way
• 0:45
  of
• 0:45
  saying
• 0:45
  it
• 0:45
  doesn't
• 0:46
  just
• 0:46
  fully
• 0:47
  block
• 0:47
  or
• 0:47
  fully
• 0:48
  stimulate.
• 0:48
  Instead
• 0:49
  it
• 0:49
  modulates.
• 0:50
  It's
• 0:51
  a
• 0:51
  bit
• 0:51
  of
• 0:51
  a
• 0:51
  dimmer
• 0:52
  switch
• 0:52
  for
• 0:53
  many
• 0:53
  of
• 0:53
  your
• 0:53
  neural
• 0:54
  circuits
• 0:54
  and
• 0:55
  I
• 0:55
  think
• 0:55
  that's
• 0:55
  what
• 0:55
  makes
• 0:56
  it
• 0:56
  feel
• 0:56
  fascinating.
• 0:57
  Some
• 0:57
  quick
• 0:57
  pearls
• 0:58
  for
• 0:58
  you
• 0:58
  again
• 0:58
  called
• 0:59
  Abilify
• 0:59
  Atypical
• 1:00
  Antipsychotic.
• 1:01
  FDA
• 1:01
  approved
• 1:02
  for
• 1:02
  schizophrenia,
• 1:04
  bipolar
• 1:05
  I
• 1:05
  disorder,
• 1:05
  adjunctive
• 1:06
  treatment
• 1:06
  of
• 1:06
  major
• 1:06
  depressive
• 1:07
  disorder,
• 1:08
  irritability
• 1:08
  and
• 1:09
  autism
• 1:09
  spectrum
• 1:10
  disorder,
• 1:10
  and
• 1:10
  Tourette's
• 1:11
  disorder.
• 1:12
  Now,
• 1:12
  dosing
• 1:12
  will
• 1:13
  vary.
• 1:13
  Every
• 1:13
  patient's
• 1:14
  different.
• 1:14
  They
• 1:14
  metabolize
• 1:15
  medications
• 1:15
  differently
• 1:16
  and
• 1:16
  react
• 1:16
  to
• 1:16
  medications
• 1:17
  differently.
• 1:18
  Everybody
• 1:18
  has
• 1:18
  a
• 1:18
  very
• 1:19
  unique
• 1:19
  clinical
• 1:19
  presentation,
• 1:20
  but
• 1:21
  typically
• 1:22
  dosing
• 1:22
  is
• 1:22
  between
• 1:23
  and
• 1:23
  schizophrenia
• 1:24
  is
• 1:24
  between
• 1:24
  10
• 1:25
  and
• 1:25
  30
• 1:25
  milligrams
• 1:26
  daily.
• 1:26
  Bipolar
• 1:27
  15
• 1:27
  to
• 1:27
  30
• 1:27
  milligrams
• 1:28
  daily.
• 1:29
  MDD
• 1:29
  is
• 1:29
  an
• 1:30
  adjunct,
• 1:30
  somewhere
• 1:30
  between
• 1:31
  2
• 1:31
  and
• 1:31
  5,
• 1:31
  maybe
• 1:32
  max
• 1:32
  at
• 1:32
  15.
• 1:33
  Again,
• 1:33
  everybody
• 1:34
  is
• 1:34
  very
• 1:35
  different.
• 1:35
  Remember,
• 1:36
  there's
• 1:36
  two
• 1:36
  different
• 1:36
  types
• 1:37
  of
• 1:37
  bipolars
• 1:37
  also,
• 1:38
  so
• 1:38
  be
• 1:38
  careful
• 1:38
  with
• 1:39
  that.
• 1:39
  But
• 1:40
  we're
• 1:40
  not
• 1:40
  going
• 1:40
  to
• 1:40
  go
• 1:40
  into
• 1:40
  that
• 1:41
  too
• 1:41
  much
• 1:41
  today
• 1:42
  we
• 1:43
  could
• 1:43
  talk
• 1:43
  about
• 1:43
  how
• 1:44
  it's
• 1:44
  Tmax
• 1:45
  is
• 1:45
  three
• 1:45
  to
• 1:45
  five
• 1:45
  hours
• 1:46
  to
• 1:46
  a
• 1:46
  maximum
• 1:47
  concentration.
• 1:48
  We
• 1:48
  can
• 1:48
  talk
• 1:48
  about
• 1:48
  how
• 1:48
  the
• 1:48
  half
• 1:49
  life
• 1:49
  is
• 1:49
  75
• 1:50
  hours,
• 1:50
  a
• 1:50
  very
• 1:51
  long
• 1:51
  medication
• 1:52
  that
• 1:52
  can
• 1:52
  often
• 1:52
  self
• 1:53
  taper.
• 1:54
  We
• 1:54
  can
• 1:54
  talk
• 1:54
  about
• 1:55
  how
• 1:55
  it
• 1:56
  is
• 1:56
  metabolized
• 1:56
  through
• 1:57
  CYP2D6
• 1:58
  or
• 1:58
  CYP3A4,
• 2:00
  how
• 2:00
  it
• 2:00
  commonly
• 2:01
  causes
• 2:01
  aesthesia
• 2:02
  or
• 2:02
  restlessness,
• 2:03
  insomnia,
• 2:04
  some
• 2:05
  weight
• 2:05
  gain.
• 2:06
  Sometimes
• 2:06
  folks
• 2:06
  have
• 2:06
  a
• 2:06
  lot
• 2:07
  of
• 2:07
  weight
• 2:07
  gain,
• 2:07
  but
• 2:07
  it
• 2:07
  is
• 2:07
  one
• 2:08
  of
• 2:08
  the
• 2:08
  more
• 2:08
  weight
• 2:09
  neutral
• 2:09
  medications.
• 2:10
  We
• 2:10
  will
• 2:10
  go
• 2:11
  into
• 2:11
  that
• 2:11
  later.
• 2:12
  But
• 2:12
  you
• 2:12
  do
• 2:13
  have
• 2:13
  to
• 2:13
  watch
• 2:13
  out
• 2:13
  for
• 2:14
  those
• 2:14
  types
• 2:14
  of
• 2:15
  concerns
• 2:15
  as
• 2:16
  well
• 2:16
  as
• 2:16
  tardive,
• 2:16
  dyskinesia
• 2:17
  and
• 2:17
  impulse
• 2:18
  control
• 2:18
  issues.
• 2:19
  Now
• 2:20
  I
• 2:20
  can't
• 2:20
  wait
• 2:20
  to
• 2:21
  talk
• 2:21
  about
• 2:21
  this
• 2:21
  today
• 2:21
  my
• 2:22
  friends
• 2:22
  because
• 2:22
  we
• 2:23
  are
• 2:23
  going
• 2:23
  to
• 2:24
  do
• 2:24
  a
• 2:24
  deep
• 2:24
  dive
• 2:25
  with
• 2:25
  Abilify
• 2:26
  through
• 2:26
  the
• 2:26
  lens
• 2:27
  of
• 2:27
  a
• 2:27
  movie
• 2:27
  theater.
• 2:29
  So
• 2:29
  I
• 2:29
  want
• 2:29
  you
• 2:29
  to
• 2:30
  think
• 2:30
  of
• 2:32
  a
• 2:32
  high
• 2:32
  functioning
• 2:33
  individual
• 2:34
  without
• 2:35
  mental
• 2:35
  illness.
• 2:36
  I
• 2:36
  want
• 2:36
  you
• 2:37
  to
• 2:37
  think
• 2:37
  of
• 2:37
  them
• 2:38
  as
• 2:38
  a
• 2:38
  movie
• 2:40
  and
• 2:40
  a
• 2:40
  movie
• 2:40
  theater
• 2:41
  that's
• 2:41
  going
• 2:41
  off
• 2:41
  without
• 2:41
  a
• 2:42
  hitch,
• 2:42
  right?
• 2:42
  People
• 2:43
  are
• 2:43
  sitting
• 2:43
  in
• 2:43
  their
• 2:43
  seats,
• 2:44
  they're
• 2:44
  eating
• 2:44
  popcorn,
• 2:45
  their
• 2:45
  arm
• 2:45
  is
• 2:45
  around
• 2:46
  their
• 2:46
  loved
• 2:46
  ones,
• 2:47
  they're
• 2:48
  enjoying
• 2:49
  a
• 2:49
  show.
• 2:49
  They're
• 2:49
  laughing
• 2:50
  appropriately
• 2:50
  at
• 2:51
  funny
• 2:51
  scenes,
• 2:52
  they're
• 2:52
  crying
• 2:52
  at
• 2:53
  the
• 2:53
  sad
• 2:53
  scenes,
• 2:54
  they
• 2:55
  clap
• 2:55
  at
• 2:55
  the
• 2:55
  end.
• 2:56
  It's
• 2:56
  just
• 2:56
  a
• 2:57
  well
• 2:57
  run
• 2:57
  movie.
• 2:58
  People
• 2:58
  can
• 2:58
  get
• 2:58
  out
• 2:58
  of
• 2:58
  their
• 2:58
  seats
• 2:59
  just
• 2:59
  fine.
• 2:59
  They
• 2:59
  go
• 3:00
  to
• 3:00
  the
• 3:00
  bathroom
• 3:00
  when
• 3:00
  they
• 3:01
  need
• 3:01
  to.
• 3:01
  It's
• 3:02
  not
• 3:02
  too
• 3:02
  loud,
• 3:02
  it's
• 3:03
  not
• 3:03
  too
• 3:03
  quiet.
• 3:03
  It's
• 3:04
  just
• 3:04
  a
• 3:04
  good
• 3:04
  ambiance.
• 3:06
  Now,
• 3:06
  in
• 3:06
  mental
• 3:07
  illness,
• 3:07
  a
• 3:08
  lot
• 3:08
  of
• 3:08
  these
• 3:08
  things
• 3:09
  go
• 3:10
  haywire,
• 3:11
  right?
• 3:12
  And
• 3:12
  so
• 3:13
  I
• 3:13
  want
• 3:13
  you
• 3:13
  to
• 3:13
  think
• 3:14
  of
• 3:15
  mental
• 3:15
  illness
• 3:16
  as
• 3:17
  a
• 3:17
  movie
• 3:18
  theater
• 3:19
  where
• 3:19
  many
• 3:20
  of
• 3:20
  the
• 3:21
  rows
• 3:21
  and
• 3:21
  aisles
• 3:22
  are
• 3:22
  not
• 3:23
  behaving
• 3:24
  the
• 3:24
  way
• 3:24
  you
• 3:24
  think
• 3:25
  they
• 3:25
  would.
• 3:25
  We're
• 3:25
  going
• 3:26
  to
• 3:26
  characterize
• 3:26
  those
• 3:27
  aisles
• 3:29
  as
• 3:30
  receptor
• 3:30
  classes.
• 3:31
  So
• 3:31
  we're
• 3:31
  going
• 3:31
  to
• 3:31
  have
• 3:31
  an
• 3:31
  IL1A
• 3:33
  and
• 3:33
  that
• 3:33
  would
• 3:33
  resemble
• 3:34
  the
• 3:34
  5ht1A
• 3:35
  receptor.
• 3:36
  We're
• 3:36
  going
• 3:37
  to
• 3:37
  have
• 3:37
  an
• 3:37
  aisle
• 3:38
  2A
• 3:39
  which
• 3:39
  resembles
• 3:40
  the
• 3:40
  5ht2A
• 3:41
  aisle.
• 3:42
  We're
• 3:42
  going
• 3:42
  to
• 3:42
  have
• 3:42
  an
• 3:42
  Aisle
• 3:43
  D2.
• 3:44
  As
• 3:44
  you
• 3:45
  will
• 3:45
  see,
• 3:45
  things
• 3:45
  are
• 3:46
  not
• 3:46
  going
• 3:46
  as
• 3:46
  smoothly
• 3:47
  as
• 3:47
  they
• 3:47
  could
• 3:47
  be.
• 3:47
  And
• 3:48
  this
• 3:48
  analogy
• 3:48
  abilifies
• 3:49
  the
• 3:49
  usher.
• 3:50
  And
• 3:50
  the
• 3:50
  usher's
• 3:51
  job
• 3:51
  is
• 3:51
  to
• 3:51
  make
• 3:51
  sure
• 3:52
  everybody
• 3:52
  in
• 3:52
  the
• 3:52
  movie
• 3:53
  theater
• 3:53
  is
• 3:54
  behaving
• 3:55
  the
• 3:55
  way
• 3:55
  they
• 3:55
  need
• 3:56
  to.
• 3:56
  It's
• 3:56
  not
• 3:56
  too
• 3:56
  loud
• 3:57
  in
• 3:57
  the
• 3:57
  movie
• 3:57
  theater,
• 3:57
  it's
• 3:58
  not
• 3:58
  too
• 3:58
  quiet.
• 3:58
  That
• 3:59
  people
• 3:59
  are
• 3:59
  able
• 3:59
  to
• 3:59
  go
• 4:00
  in
• 4:00
  and
• 4:00
  out
• 4:00
  of
• 4:00
  their
• 4:00
  seats
• 4:01
  as
• 4:01
  needed
• 4:01
  to
• 4:01
  get
• 4:02
  food
• 4:02
  and
• 4:02
  snack
• 4:03
  appropriately,
• 4:04
  that
• 4:04
  they're
• 4:04
  being
• 4:04
  entertained,
• 4:05
  that
• 4:05
  they're
• 4:06
  not
• 4:06
  too
• 4:06
  nervous,
• 4:06
  that
• 4:07
  they're
• 4:07
  not
• 4:07
  sleeping,
• 4:07
  slouched
• 4:08
  in
• 4:08
  their
• 4:08
  seats
• 4:08
  and
• 4:09
  barely
• 4:09
  paying
• 4:10
  attention,
• 4:10
  but
• 4:10
  that
• 4:10
  they're
• 4:11
  just
• 4:11
  enjoying
• 4:12
  the
• 4:12
  show
• 4:12
  and
• 4:12
  things
• 4:12
  are
• 4:13
  going
• 4:13
  off
• 4:13
  without
• 4:14
  a
• 4:14
  hitch.
• 4:14
  That's
• 4:14
  the
• 4:14
  usher's
• 4:15
  job,
• 4:15
  and
• 4:16
  in
• 4:16
  this
• 4:16
  case
• 4:16
  abilifies
• 4:17
  the
• 4:17
  usher,
• 4:17
  whose
• 4:18
  job
• 4:18
  is
• 4:18
  to
• 4:18
  make
• 4:18
  sure
• 4:18
  the
• 4:19
  movie
• 4:19
  theater,
• 4:19
  AKA
• 4:20
  your
• 4:20
  life
• 4:21
  or
• 4:21
  your
• 4:21
  mental
• 4:22
  health
• 4:22
  is
• 4:22
  being
• 4:23
  experienced
• 4:24
  optimally.
• 4:24
  Now,
• 4:25
  I
• 4:25
  want
• 4:25
  you
• 4:25
  all
• 4:25
  to
• 4:26
  think
• 4:26
  about
• 4:26
  abilify
• 4:27
  as
• 4:27
  a
• 4:28
  mood
• 4:28
  stabilizer
• 4:29
  and
• 4:29
  a
• 4:30
  way
• 4:30
  to
• 4:30
  lessen
• 4:31
  or
• 4:31
  eliminate
• 4:32
  psychosis.
• 4:32
  So
• 4:33
  let's
• 4:34
  zip
• 4:34
  over
• 4:34
  to
• 4:35
  row
• 4:35
  D2.
• 4:36
  Okay?
• 4:37
  And
• 4:37
  our
• 4:38
  D2
• 4:38
  receptors
• 4:39
  are
• 4:39
  overactive
• 4:40
  in
• 4:40
  the
• 4:40
  limbic
• 4:41
  area,
• 4:41
  right?
• 4:41
  So
• 4:41
  we
• 4:42
  have
• 4:42
  hallucinations,
• 4:43
  unstable
• 4:43
  mood,
• 4:44
  and
• 4:44
  mania.
• 4:44
  The
• 4:45
  Moviegoers
• 4:45
  in
• 4:45
  Section
• 4:46
  2
• 4:46
  in
• 4:47
  D2
• 4:48
  are
• 4:48
  laughing
• 4:49
  at
• 4:49
  inappropriate
• 4:50
  times
• 4:50
  of
• 4:50
  the
• 4:51
  movie.
• 4:51
  Some
• 4:52
  of
• 4:52
  them
• 4:52
  are
• 4:52
  a
• 4:53
  little
• 4:53
  bit
• 4:53
  manic.
• 4:54
  They're
• 4:54
  jumping
• 4:55
  out
• 4:55
  of
• 4:55
  their
• 4:55
  seats,
• 4:55
  pretending
• 4:56
  they're
• 4:56
  Superman,
• 4:57
  flying
• 4:57
  around
• 4:57
  the
• 4:58
  movie
• 4:58
  theater.
• 4:59
  They're
• 4:59
  hearing
• 4:59
  voices
• 5:00
  during
• 5:00
  the
• 5:00
  movie,
• 5:00
  so
• 5:00
  they
• 5:01
  can't
• 5:01
  focus
• 5:01
  very
• 5:01
  easily.
• 5:02
  They
• 5:03
  are
• 5:04
  emotionally
• 5:05
  labile
• 5:05
  crying
• 5:06
  really
• 5:06
  hard.
• 5:07
  Sometimes
• 5:07
  at
• 5:07
  the
• 5:07
  happy
• 5:08
  parts,
• 5:08
  sometimes
• 5:09
  at
• 5:09
  the
• 5:09
  sad
• 5:09
  parts.
• 5:10
  They're
• 5:10
  just
• 5:11
  not
• 5:12
  very
• 5:12
  emotionally
• 5:13
  regulated.
• 5:14
  They're
• 5:14
  hallucinating.
• 5:15
  Seeing
• 5:15
  bear
• 5:15
  attacks
• 5:16
  when
• 5:16
  it's
• 5:16
  a
• 5:17
  wedding
• 5:17
  scene.
• 5:18
  So
• 5:18
  they're
• 5:18
  not
• 5:18
  even
• 5:19
  really
• 5:19
  in
• 5:19
  tune
• 5:20
  with
• 5:20
  what
• 5:20
  the
• 5:20
  movie's
• 5:21
  actually
• 5:21
  showing
• 5:21
  them.
• 5:22
  Now,
• 5:22
  Abilify,
• 5:23
  or
• 5:23
  the
• 5:23
  usher
• 5:24
  is
• 5:24
  going
• 5:24
  to
• 5:24
  go
• 5:24
  to
• 5:24
  that
• 5:24
  row
• 5:26
  and
• 5:26
  it's
• 5:26
  going
• 5:26
  to
• 5:26
  kind
• 5:26
  of
• 5:26
  tone
• 5:27
  things
• 5:28
  down,
• 5:28
  right?
• 5:29
  That's
• 5:29
  what
• 5:29
  Abilify
• 5:30
  does.
• 5:30
  It'll
• 5:30
  antagonize
• 5:31
  the
• 5:31
  D2
• 5:32
  row,
• 5:32
  or
• 5:32
  in
• 5:33
  this
• 5:33
  case,
• 5:33
  it's
• 5:33
  going
• 5:34
  to
• 5:34
  go
• 5:34
  there
• 5:34
  and
• 5:34
  kind
• 5:34
  of
• 5:35
  lessen
• 5:35
  that
• 5:36
  particular
• 5:36
  section,
• 5:37
  right?
• 5:38
  The
• 5:38
  dopaminergic
• 5:39
  circuits
• 5:39
  in
• 5:39
  the
• 5:39
  mesolimbic
• 5:40
  pathway.
• 5:40
  And
• 5:41
  it's
• 5:41
  going
• 5:41
  to
• 5:41
  kind
• 5:41
  of
• 5:42
  just
• 5:42
  calm
• 5:42
  things
• 5:42
  down.
• 5:43
  He's
• 5:43
  going
• 5:43
  to
• 5:43
  go
• 5:43
  over
• 5:43
  there
• 5:44
  and
• 5:45
  just
• 5:46
  allow
• 5:47
  these
• 5:47
  people
• 5:47
  to
• 5:48
  relax
• 5:49
  and
• 5:50
  help
• 5:50
  them
• 5:51
  watch
• 5:51
  the
• 5:51
  show.
• 5:52
  They're
• 5:52
  not
• 5:52
  as
• 5:53
  intense
• 5:53
  anymore.
• 5:54
  They're
• 5:54
  back
• 5:54
  in
• 5:54
  their
• 5:55
  seats.
• 5:55
  They're
• 5:55
  kind
• 5:55
  of
• 5:56
  relaxed,
• 5:57
  right?
• 5:57
  And
• 5:58
  unlike
• 5:58
  Haldol,
• 5:59
  Haldol
• 5:59
  is
• 6:00
  a
• 6:00
  first
• 6:00
  generation
• 6:00
  antipsychotic.
• 6:01
  It's
• 6:01
  the
• 6:01
  old
• 6:02
  school
• 6:02
  usher
• 6:02
  that
• 6:02
  goes
• 6:03
  in
• 6:03
  there
• 6:03
  and
• 6:03
  goes,
• 6:03
  okay,
• 6:04
  no
• 6:04
  more
• 6:04
  hallucinations,
• 6:05
  no
• 6:05
  more
• 6:05
  manic
• 6:05
  behavior,
• 6:06
  no
• 6:06
  more
• 6:06
  delusions.
• 6:07
  We're
• 6:07
  going
• 6:07
  to
• 6:07
  go
• 6:07
  in
• 6:07
  there
• 6:08
  and
• 6:08
  shut
• 6:09
  everything
• 6:09
  down.
• 6:09
  Imagine
• 6:10
  Haldol,
• 6:10
  the
• 6:10
  old
• 6:10
  school
• 6:11
  usher,
• 6:11
  he's
• 6:12
  just
• 6:12
  locking
• 6:13
  everything
• 6:13
  up.
• 6:13
  He's
• 6:13
  throwing
• 6:14
  people
• 6:14
  out
• 6:14
  of
• 6:14
  the
• 6:14
  movie
• 6:14
  theater
• 6:15
  entirely
• 6:15
  so
• 6:15
  they're
• 6:16
  not
• 6:16
  making
• 6:16
  any
• 6:16
  more
• 6:16
  noise
• 6:17
  or
• 6:17
  the
• 6:17
  people
• 6:18
  in
• 6:18
  the
• 6:18
  movie
• 6:18
  theater,
• 6:19
  he
• 6:19
  duct
• 6:19
  tapes
• 6:20
  them
• 6:20
  to
• 6:20
  their
• 6:20
  seat.
• 6:21
  He
• 6:21
  duct
• 6:21
  tapes
• 6:22
  their
• 6:22
  mouth.
• 6:22
  They're
• 6:22
  in
• 6:23
  straight
• 6:23
  jackets,
• 6:23
  so
• 6:23
  they
• 6:24
  can't
• 6:24
  move
• 6:24
  anymore,
• 6:24
  right?
• 6:25
  They
• 6:25
  can
• 6:25
  see
• 6:26
  the
• 6:26
  movie.
• 6:26
  The
• 6:26
  movie
• 6:27
  now
• 6:27
  is
• 6:27
  clear
• 6:27
  to
• 6:27
  them.
• 6:28
  They're
• 6:28
  not
• 6:28
  hallucinating
• 6:29
  or
• 6:29
  laughing
• 6:29
  at
• 6:30
  weird
• 6:30
  times.
• 6:31
  They're
• 6:31
  almost
• 6:31
  so
• 6:32
  relaxed
• 6:32
  that
• 6:32
  they're
• 6:32
  dull,
• 6:33
  right?
• 6:33
  And
• 6:33
  they're
• 6:34
  in
• 6:34
  straitjackets.
• 6:35
  That's
• 6:35
  the
• 6:35
  only
• 6:35
  way
• 6:36
  that
• 6:36
  Usher
• 6:36
  knew
• 6:37
  how
• 6:37
  to
• 6:37
  calm
• 6:37
  things
• 6:37
  down.
• 6:38
  And
• 6:38
  so
• 6:38
  even
• 6:39
  though
• 6:39
  they're
• 6:39
  able
• 6:39
  to
• 6:40
  watch
• 6:40
  the
• 6:40
  movie,
• 6:41
  it
• 6:41
  comes
• 6:41
  at
• 6:42
  the
• 6:42
  expense
• 6:42
  of
• 6:42
  their
• 6:42
  comfort.
• 6:43
  Right
• 6:43
  now
• 6:43
  they're
• 6:44
  rigid.
• 6:44
  They're
• 6:44
  in
• 6:44
  straitjackets.
• 6:45
  They
• 6:45
  can't
• 6:45
  really
• 6:45
  move
• 6:46
  their
• 6:46
  arms
• 6:46
  and
• 6:46
  legs.
• 6:47
  A
• 6:47
  lot
• 6:47
  of.
• 6:48
  And
• 6:48
  that's
• 6:48
  really
• 6:49
  not
• 6:49
  fun.
• 6:50
  They're
• 6:50
  so
• 6:50
  tight
• 6:51
  that
• 6:51
  when
• 6:51
  they
• 6:51
  try
• 6:52
  to
• 6:52
  get
• 6:52
  up
• 6:52
  and
• 6:52
  walk,
• 6:52
  they're
• 6:52
  just
• 6:53
  shuffling
• 6:53
  around
• 6:53
  because
• 6:54
  they're
• 6:54
  not
• 6:54
  moving
• 6:54
  very
• 6:55
  easily
• 6:55
  in
• 6:55
  their
• 6:55
  straight
• 6:56
  jackets.
• 6:56
  They're
• 6:56
  not
• 6:57
  doing
• 6:57
  very
• 6:57
  well
• 6:58
  because
• 6:58
  the
• 6:58
  old
• 6:58
  school
• 6:59
  usher
• 6:59
  just
• 6:59
  shut
• 7:00
  everything
• 7:00
  down.
• 7:00
  That's
• 7:01
  what
• 7:01
  Haldol
• 7:01
  tends
• 7:01
  to
• 7:01
  do.
• 7:02
  It
• 7:02
  blockades
• 7:02
  much
• 7:03
  more
• 7:03
  of
• 7:03
  that
• 7:03
  dopamine
• 7:04
  than
• 7:04
  Abilify
• 7:05
  because
• 7:05
  again,
• 7:06
  Abilify
• 7:06
  is
• 7:06
  a
• 7:07
  partial
• 7:07
  agonist.
• 7:07
  So
• 7:08
  it
• 7:08
  abilifies
• 7:08
  the
• 7:08
  usher
• 7:09
  that
• 7:09
  just
• 7:09
  kind
• 7:09
  of
• 7:09
  tells
• 7:10
  everybody
• 7:10
  to
• 7:10
  just
• 7:10
  shush
• 7:11
  down
• 7:11
  a
• 7:11
  little
• 7:11
  bit
• 7:12
  and
• 7:12
  cool
• 7:12
  off,
• 7:13
  right?
• 7:14
  He
• 7:14
  kind
• 7:14
  of
• 7:14
  reorients
• 7:15
  them
• 7:15
  to
• 7:15
  the
• 7:15
  movie
• 7:15
  and
• 7:15
  the
• 7:16
  space.
• 7:16
  And
• 7:17
  so
• 7:17
  folks
• 7:17
  are
• 7:18
  not
• 7:18
  as
• 7:18
  labile
• 7:18
  or
• 7:19
  psychotic,
• 7:19
  but
• 7:20
  there's
• 7:20
  still
• 7:20
  a
• 7:20
  bit
• 7:20
  of
• 7:20
  a
• 7:21
  dope
• 7:21
  push
• 7:22
  there
• 7:22
  because
• 7:22
  it's
• 7:22
  a
• 7:22
  partial
• 7:23
  agonist,
• 7:23
  right?
• 7:23
  Abilifies
• 7:24
  a
• 7:24
  dimmer
• 7:24
  switch.
• 7:25
  It's
• 7:25
  the
• 7:25
  usher
• 7:26
  who
• 7:26
  just
• 7:26
  shushes
• 7:27
  them
• 7:27
  quietly
• 7:27
  rather
• 7:27
  than
• 7:28
  puts
• 7:28
  them
• 7:28
  in
• 7:29
  straight
• 7:29
  jackets
• 7:30
  and
• 7:30
  immobilizes
• 7:31
  them.
• 7:31
  And
• 7:32
  so
• 7:32
  they
• 7:32
  have
• 7:32
  less
• 7:32
  of
• 7:33
  that
• 7:33
  rigidity
• 7:33
  going
• 7:34
  on,
• 7:34
  which
• 7:35
  is
• 7:35
  very
• 7:35
  beneficial.
• 7:36
  Less
• 7:36
  of
• 7:36
  the
• 7:36
  side
• 7:37
  effects.
• 7:37
  Because
• 7:37
  the
• 7:38
  first
• 7:38
  old
• 7:38
  school
• 7:38
  usher,
• 7:39
  the
• 7:39
  Haldol
• 7:39
  usher,
• 7:39
  he
• 7:40
  came
• 7:40
  in
• 7:40
  and
• 7:40
  he
• 7:40
  was
• 7:40
  really
• 7:41
  rigid
• 7:41
  and
• 7:41
  old
• 7:41
  school
• 7:42
  and
• 7:42
  put
• 7:42
  them
• 7:42
  all
• 7:42
  in
• 7:43
  straight
• 7:43
  jackets.
• 7:43
  Did
• 7:44
  a
• 7:44
  darn
• 7:44
  good
• 7:44
  job
• 7:44
  of
• 7:44
  quieting
• 7:45
  things
• 7:45
  down,
• 7:45
  though,
• 7:46
  right?
• 7:46
  There
• 7:46
  weren't
• 7:47
  people
• 7:47
  hallucinating
• 7:48
  anymore
• 7:49
  or
• 7:49
  thinking
• 7:49
  they're
• 7:50
  watching
• 7:50
  a
• 7:51
  rom
• 7:51
  com
• 7:51
  when
• 7:51
  they're
• 7:52
  watching
• 7:52
  a
• 7:52
  bear
• 7:52
  attack
• 7:53
  or
• 7:53
  a
• 7:53
  Superman.
• 7:54
  But
• 7:54
  it
• 7:55
  came
• 7:55
  at
• 7:55
  the
• 7:55
  expense
• 7:55
  of
• 7:56
  their
• 7:56
  comfort.
• 7:56
  They're
• 7:57
  slouched
• 7:57
  in
• 7:57
  their
• 7:57
  chair,
• 7:57
  not
• 7:58
  enjoying
• 7:58
  much.
• 7:59
  Their
• 7:59
  dopamine
• 8:00
  tone
• 8:00
  is
• 8:00
  dull
• 8:00
  and
• 8:01
  down,
• 8:01
  and
• 8:01
  they're
• 8:02
  rigid.
• 8:02
  Abilify
• 8:03
  is
• 8:03
  a
• 8:03
  more
• 8:04
  flexible
• 8:04
  usher
• 8:04
  who
• 8:05
  chills
• 8:05
  things
• 8:05
  out.
• 8:06
  Now,
• 8:07
  I
• 8:07
  want
• 8:07
  us
• 8:07
  to
• 8:07
  move
• 8:08
  to
• 8:09
  another
• 8:09
  receptor
• 8:09
  class
• 8:10
  that
• 8:10
  Abilify
• 8:10
  works
• 8:11
  on,
• 8:11
  and
• 8:11
  that's
• 8:11
  5ht.
• 8:12
  1a.
• 8:13
  You
• 8:14
  might
• 8:14
  have
• 8:14
  heard
• 8:14
  of
• 8:14
  this
• 8:14
  receptor
• 8:15
  class
• 8:15
  in.
• 8:15
  In.
• 8:16
  In.
• 8:16
  Well,
• 8:16
  and.
• 8:16
  Excuse
• 8:17
  me,
• 8:17
  in.
• 8:17
  In.
• 8:17
  Buspirone.
• 8:18
  And
• 8:19
  that's
• 8:19
  a
• 8:19
  very
• 8:19
  interesting
• 8:20
  receptor
• 8:20
  class.
• 8:20
  Now,
• 8:21
  it's
• 8:21
  usually
• 8:21
  implicated
• 8:22
  in
• 8:22
  anxiety.
• 8:23
  So
• 8:23
  Abilify
• 8:24
  does,
• 8:24
  in
• 8:24
  fact,
• 8:25
  partially
• 8:25
  agonize
• 8:26
  the
• 8:27
  1A
• 8:27
  receptor.
• 8:28
  What
• 8:28
  that
• 8:28
  does
• 8:28
  is,
• 8:29
  like
• 8:29
  the
• 8:29
  usher,
• 8:29
  Abilify
• 8:30
  is
• 8:30
  going
• 8:30
  up
• 8:30
  to
• 8:30
  row
• 8:31
  1A.
• 8:31
  These
• 8:31
  folks
• 8:32
  are
• 8:32
  really
• 8:32
  nervous,
• 8:33
  anxious,
• 8:33
  pacing
• 8:34
  around,
• 8:34
  getting
• 8:35
  out
• 8:35
  of
• 8:35
  their
• 8:35
  chairs,
• 8:36
  nervously
• 8:36
  whispering
• 8:37
  to
• 8:37
  each
• 8:37
  other.
• 8:37
  They're
• 8:37
  fidgeting,
• 8:38
  nervous
• 8:38
  about
• 8:38
  the
• 8:39
  next
• 8:39
  scene,
• 8:39
  and
• 8:40
  they're
• 8:40
  easily
• 8:40
  spooked.
• 8:41
  Anytime,
• 8:42
  anytime
• 8:42
  they
• 8:42
  see
• 8:42
  the
• 8:42
  bear
• 8:43
  on
• 8:43
  the
• 8:43
  movie,
• 8:43
  they
• 8:43
  jump
• 8:44
  out
• 8:44
  of
• 8:44
  their
• 8:44
  chairs.
• 8:44
  They're
• 8:45
  very
• 8:46
  nervous
• 8:46
  to
• 8:46
  the
• 8:46
  point
• 8:46
  where
• 8:47
  they're
• 8:47
  not
• 8:47
  enjoying
• 8:47
  anything
• 8:48
  either.
• 8:48
  They're
• 8:48
  actually
• 8:49
  blunting
• 8:50
  their
• 8:50
  dopamine
• 8:51
  response,
• 8:51
  right?
• 8:51
  There's
• 8:52
  so
• 8:52
  much
• 8:52
  dysregulated
• 8:53
  serotonergic
• 8:54
  activity
• 8:55
  that
• 8:55
  it
• 8:55
  actually
• 8:56
  puts
• 8:56
  a
• 8:56
  clamp
• 8:56
  on
• 8:57
  dopamine.
• 8:57
  And
• 8:58
  they're
• 8:58
  feeling.
• 8:59
  They
• 9:00
  can't
• 9:00
  really
• 9:00
  focus
• 9:00
  very
• 9:01
  well
• 9:01
  and
• 9:01
  they
• 9:02
  can't
• 9:02
  really
• 9:02
  think
• 9:02
  clearly,
• 9:03
  and
• 9:03
  they're
• 9:04
  not
• 9:04
  enjoying
• 9:04
  their
• 9:05
  lives.
• 9:05
  There's
• 9:05
  kind
• 9:05
  of
• 9:06
  a
• 9:06
  muted
• 9:06
  joy
• 9:06
  response,
• 9:07
  right?
• 9:07
  That
• 9:08
  excess
• 9:08
  serotonergic
• 9:09
  activity
• 9:09
  is
• 9:10
  blunting
• 9:10
  their
• 9:10
  dopamine
• 9:11
  response,
• 9:11
  which
• 9:12
  makes
• 9:12
  perfect
• 9:12
  sense
• 9:12
  if
• 9:13
  you're
• 9:13
  that
• 9:13
  dysregulated
• 9:14
  in
• 9:14
  your
• 9:14
  limbic
• 9:15
  areas.
• 9:15
  If
• 9:15
  you're
• 9:16
  that
• 9:16
  jumpy
• 9:17
  in
• 9:17
  your
• 9:17
  seat,
• 9:18
  you're
• 9:18
  not
• 9:18
  going
• 9:18
  to
• 9:18
  enjoy
• 9:18
  the
• 9:18
  movie,
• 9:19
  right?
• 9:19
  So
• 9:19
  what
• 9:20
  happens
• 9:20
  is
• 9:20
  the
• 9:20
  usher,
• 9:21
  Abilify,
• 9:21
  comes
• 9:22
  over
• 9:22
  and
• 9:22
  just
• 9:22
  kind
• 9:22
  of
• 9:23
  gives
• 9:23
  them
• 9:23
  a
• 9:23
  gentle
• 9:23
  back
• 9:24
  massage
• 9:24
  in
• 9:24
  row
• 9:25
  1A
• 9:25
  and
• 9:25
  says,
• 9:25
  Things
• 9:26
  are
• 9:26
  going
• 9:26
  to
• 9:26
  be
• 9:26
  okay.
• 9:27
  Go
• 9:27
  ahead
• 9:27
  and
• 9:27
  just
• 9:27
  watch
• 9:27
  the
• 9:28
  movie.
• 9:28
  Everything's
• 9:28
  going
• 9:28
  to
• 9:28
  be
• 9:29
  all
• 9:29
  right.
• 9:29
  And
• 9:30
  so
• 9:30
  their
• 9:30
  limbic
• 9:31
  firing
• 9:31
  kind
• 9:31
  of
• 9:31
  goes
• 9:32
  down
• 9:32
  because
• 9:32
  of
• 9:33
  the
• 9:33
  serotonergic
• 9:34
  dampening.
• 9:35
  The
• 9:35
  serotonin
• 9:36
  is
• 9:36
  not
• 9:36
  as
• 9:37
  excessive
• 9:37
  or
• 9:37
  dysregulated.
• 9:38
  It
• 9:39
  allows
• 9:39
  their
• 9:39
  dopamine
• 9:40
  release
• 9:40
  to
• 9:40
  go
• 9:40
  up
• 9:41
  in
• 9:41
  the
• 9:41
  prefrontal
• 9:42
  cortex,
• 9:42
  and
• 9:42
  that
• 9:42
  improves
• 9:43
  their
• 9:43
  mood
• 9:43
  and
• 9:44
  their
• 9:44
  concentration
• 9:44
  and
• 9:45
  their
• 9:45
  ability
• 9:45
  to
• 9:45
  watch
• 9:46
  the
• 9:46
  movies.
• 9:46
  That's
• 9:46
  a
• 9:46
  really
• 9:47
  cool
• 9:47
  thing
• 9:47
  that
• 9:48
  Abilify
• 9:48
  does
• 9:49
  as
• 9:49
  well.
• 9:49
  Notice
• 9:49
  Abilify
• 9:50
  does
• 9:50
  not
• 9:50
  flood
• 9:51
  you
• 9:51
  with
• 9:51
  serotonin.
• 9:52
  It
• 9:52
  just
• 9:52
  balances
• 9:52
  your
• 9:53
  serotonin,
• 9:54
  right?
• 10:49
  And
• 10:49
  it
• 10:49
  stimulates
• 10:50
  1A
• 10:51
  just
• 10:51
  enough
• 10:51
  to
• 10:51
  calm
• 10:51
  the
• 9:57
  nerves,
• 10:52
  but
• 10:52
  opens
• 10:53
  the
• 10:53
  door
• 10:54
  for
• 10:54
  dopamine
• 10:54
  to
• 10:54
  work
• 10:55
  better
• 10:55
  in
• 10:55
  the
• 10:55
  prefrontal
• 10:56
  cortex
• 10:56
  again,
• 10:56
  because
• 10:57
  if
• 10:57
  you're
• 10:57
  all
• 10:57
  nervous
• 10:57
  and
• 10:58
  fidgety
• 10:58
  and
• 10:58
  pacing
• 10:59
  out
• 10:59
  of
• 10:59
  your
• 10:59
  seat
• 10:59
  and
• 11:00
  in
• 11:00
  between
• 11:00
  the
• 11:00
  aisles
• 11:01
  and
• 11:01
  you
• 11:01
  can't
• 11:01
  enjoy
• 11:01
  the
• 11:02
  show,
• 11:02
  you're
• 11:02
  not
• 11:03
  going
• 11:03
  to
• 11:03
  enjoy
• 11:04
  the
• 11:04
  show.
• 11:04
  Your
• 11:04
  dopamine
• 11:05
  response
• 11:05
  is
• 11:05
  also
• 11:05
  going
• 11:06
  to
• 11:06
  take
• 11:06
  a
• 11:06
  hit.
• 11:07
  And
• 11:07
  so
• 11:07
  abilify
• 11:08
  comes
• 11:08
  into
• 11:08
  1a
• 11:09
  and
• 11:09
  calms
• 11:10
  things
• 11:10
  down.
• 11:10
  Now,
• 11:11
  that's
• 11:11
  pretty
• 11:11
  cool,
• 11:11
  right?
• 11:12
  We've
• 11:12
  had
• 11:12
  a
• 11:12
  medication
• 11:13
  or
• 11:13
  an
• 11:13
  usher
• 11:13
  who's
• 11:14
  really
• 11:14
  controlling
• 11:14
  things
• 11:15
  around
• 11:15
  the
• 11:15
  movie
• 11:15
  theater,
• 11:16
  right?
• 11:16
  He's
• 11:17
  keeping
• 11:18
  the
• 11:18
  laughing
• 11:18
  at
• 11:19
  inappropriate
• 11:19
  times,
• 11:20
  rowdy
• 11:21
  manic
• 11:21
  behavior
• 11:21
  where
• 11:21
  people
• 11:22
  are
• 11:22
  throwing
• 11:23
  popcorn
• 11:23
  at
• 11:23
  each
• 11:23
  other
• 11:24
  and
• 11:24
  jumping
• 11:24
  on
• 11:24
  their
• 11:24
  seats,
• 11:25
  beating
• 11:25
  their
• 11:25
  chest
• 11:26
  really
• 11:26
  confidently,
• 11:27
  right?
• 11:28
  He's
• 11:29
  calming
• 11:29
  that
• 11:29
  part
• 11:29
  of
• 11:29
  the
• 11:29
  movie
• 11:30
  theater
• 11:30
  in
• 11:30
  D2
• 11:31
  that
• 11:31
  was
• 11:31
  way
• 11:31
  dysregulated.
• 11:32
  Now
• 11:33
  he's
• 11:33
  calming
• 11:33
  1A.
• 11:34
  They
• 11:34
  were
• 11:34
  a
• 11:35
  little
• 11:35
  nervous
• 11:35
  during
• 11:35
  a
• 11:35
  lot
• 11:36
  of
• 11:36
  the
• 11:36
  scene.
• 11:36
  They
• 11:36
  couldn't
• 11:37
  enjoy
• 11:37
  the
• 11:37
  show.
• 11:37
  So
• 11:37
  the
• 11:38
  show
• 11:38
  is
• 11:38
  getting
• 11:38
  a
• 11:38
  lot
• 11:38
  more
• 11:39
  regulated.
• 11:39
  It's
• 11:39
  a
• 11:40
  lot
• 11:40
  better
• 11:40
  now.
• 11:40
  We
• 11:41
  still
• 11:41
  have
• 11:41
  a
• 11:41
  problem.
• 11:41
  There's
• 11:42
  some
• 11:42
  punk
• 11:42
  teenagers
• 11:43
  in
• 11:43
  this
• 11:44
  movie
• 11:44
  theater
• 11:44
  spilling
• 11:45
  their
• 11:45
  soda
• 11:46
  everywhere.
• 11:47
  They're
• 11:48
  throwing
• 11:48
  popcorn
• 11:49
  at
• 11:49
  random
• 11:49
  people,
• 11:50
  and
• 11:51
  that's
• 11:51
  really
• 11:51
  bad.
• 11:52
  People
• 11:52
  are
• 11:52
  not
• 11:52
  enjoying
• 11:53
  the
• 11:53
  show
• 11:53
  as
• 11:53
  much
• 11:54
  because
• 11:54
  their
• 11:54
  feet
• 11:55
  are
• 11:55
  stuck
• 11:55
  to
• 11:55
  the
• 11:55
  floor.
• 11:56
  They
• 11:56
  can't
• 11:57
  move
• 11:57
  them
• 11:57
  around
• 11:57
  very
• 11:57
  easily
• 11:58
  and
• 11:58
  get
• 11:58
  up
• 11:58
  and.
• 11:59
  And
• 11:59
  go
• 11:59
  to
• 11:59
  the
• 11:59
  bathroom
• 12:00
  because
• 12:00
  their
• 12:00
  feet
• 12:00
  are
• 12:01
  stuck.
• 12:01
  From
• 12:01
  these
• 12:02
  punk
• 12:02
  teenagers.
• 12:02
  This
• 12:03
  is
• 12:03
  happening
• 12:03
  around
• 12:03
  5ht
• 12:04
  2a
• 12:05
  or
• 12:05
  row
• 12:05
  2a.
• 12:06
  And
• 12:07
  it's
• 12:07
  a
• 12:07
  problem,
• 12:07
  right?
• 12:08
  Because
• 12:09
  we
• 12:09
  don't
• 12:09
  want
• 12:10
  people
• 12:10
  to
• 12:10
  feel
• 12:10
  rigid.
• 12:11
  They're,
• 12:11
  you
• 12:12
  know,
• 12:12
  we
• 12:12
  want
• 12:12
  them
• 12:12
  to
• 12:12
  get
• 12:12
  up
• 12:13
  and
• 12:13
  move
• 12:13
  freely
• 12:14
  if
• 12:14
  they
• 12:14
  need
• 12:14
  to
• 12:14
  go
• 12:14
  to
• 12:14
  the
• 12:14
  bathroom
• 12:15
  or
• 12:16
  exit
• 12:16
  their
• 12:16
  seat
• 12:16
  for
• 12:17
  whatever
• 12:17
  reason,
• 12:17
  for
• 12:18
  an
• 12:18
  emergency,
• 12:18
  a
• 12:19
  fire,
• 12:19
  whatever.
• 12:19
  We
• 12:20
  need
• 12:20
  them
• 12:20
  to
• 12:20
  be
• 12:20
  a
• 12:20
  little
• 12:21
  bit
• 12:21
  mobile
• 12:21
  and
• 12:21
  enjoy
• 12:22
  the
• 12:22
  show,
• 12:22
  right?
• 12:22
  We
• 12:22
  want
• 12:22
  them
• 12:23
  to
• 12:23
  be
• 12:23
  able
• 12:23
  to
• 12:23
  put
• 12:23
  their
• 12:23
  arm
• 12:24
  around
• 12:24
  their
• 12:24
  spouse
• 12:25
  and
• 12:25
  not
• 12:25
  just
• 12:25
  be
• 12:26
  rigid
• 12:26
  in
• 12:26
  their
• 12:26
  chair.
• 12:27
  And
• 12:27
  in
• 12:28
  this
• 12:28
  freeze
• 12:28
  response,
• 12:29
  these
• 12:29
  little
• 12:29
  punk
• 12:29
  teenagers
• 12:30
  keep
• 12:30
  throwing
• 12:30
  popcorn
• 12:31
  at
• 12:31
  them
• 12:31
  and
• 12:31
  attacking
• 12:32
  them.
• 12:32
  This
• 12:33
  would
• 12:33
  be
• 12:33
  like
• 12:33
  5ht
• 12:34
  2a
• 12:34
  and
• 12:34
  the
• 12:35
  usher
• 12:35
  or
• 12:35
  billify
• 12:36
  marches
• 12:36
  over
• 12:37
  to
• 12:37
  that
• 12:37
  row
• 12:38
  and
• 12:39
  throws
• 12:39
  those
• 12:40
  punk
• 12:40
  kids
• 12:40
  out
• 12:40
  of
• 12:41
  the
• 12:41
  movie
• 12:41
  theater
• 12:42
  and
• 12:42
  cleans
• 12:42
  up
• 12:42
  the
• 12:43
  aisle.
• 12:43
  So
• 12:43
  that
• 12:44
  would
• 12:44
  be
• 12:44
  like
• 12:44
  antagonizing
• 12:45
  5ht
• 12:46
  2a.
• 12:46
  And
• 12:47
  this
• 12:47
  is
• 12:47
  really
• 12:47
  important
• 12:47
  because
• 12:48
  by
• 12:48
  antagonizing
• 12:49
  5ht
• 12:50
  2a,
• 12:50
  people
• 12:50
  are
• 12:51
  less
• 12:51
  rigid
• 12:51
  and
• 12:52
  they
• 12:52
  enjoy
• 12:52
  the
• 12:52
  show
• 12:52
  a
• 12:53
  little
• 12:53
  bit
• 12:53
  more,
• 12:53
  too.
• 12:54
  Blocking
• 12:54
  5ht2a
• 12:55
  also
• 12:56
  has
• 12:57
  this
• 12:57
  nice
• 12:57
  improvement
• 12:58
  in
• 12:59
  cognition,
• 12:59
  executive
• 13:00
  functioning,
• 13:00
  and
• 13:00
  mood.
• 13:01
  When
• 13:01
  you
• 13:01
  have
• 13:01
  a
• 13:02
  medication
• 13:02
  that
• 13:02
  blocks
• 13:03
  5ht
• 13:03
  2a,
• 13:04
  you're
• 13:04
  sparing
• 13:05
  that
• 13:05
  patient
• 13:06
  from
• 13:06
  a
• 13:06
  little
• 13:06
  bit
• 13:07
  of
• 13:07
  the
• 13:07
  motor
• 13:07
  problems
• 13:08
  they
• 13:08
  would
• 13:08
  otherwise
• 13:09
  experience
• 13:09
  with
• 13:09
  that
• 13:09
  really
• 13:10
  harsh
• 13:10
  usher,
• 13:10
  that
• 13:11
  Haldol
• 13:11
  usher
• 13:12
  who
• 13:12
  comes
• 13:12
  in
• 13:12
  and
• 13:13
  everybody's
• 13:13
  in
• 13:13
  a
• 13:13
  straight
• 13:14
  jacket,
• 13:14
  right?
• 13:15
  And
• 13:15
  maybe
• 13:15
  he
• 13:15
  calmed
• 13:16
  the
• 13:16
  hallucinations
• 13:16
  down,
• 13:16
  the
• 13:17
  rowdy,
• 13:17
  manic,
• 13:18
  you
• 13:18
  know,
• 13:18
  psychotic
• 13:19
  behavior,
• 13:20
  but
• 13:20
  he
• 13:20
  didn't
• 13:20
  do
• 13:21
  a
• 13:21
  lot.
• 13:21
  He
• 13:21
  did
• 13:22
  it
• 13:22
  at
• 13:22
  the
• 13:22
  expense
• 13:22
  of
• 13:23
  how
• 13:23
  people
• 13:24
  can
• 13:24
  go
• 13:24
  about
• 13:25
  walking
• 13:25
  around
• 13:26
  freely,
• 13:26
  putting
• 13:27
  their
• 13:27
  arms
• 13:27
  around
• 13:27
  their
• 13:28
  spouses,
• 13:28
  using
• 13:28
  their
• 13:29
  hands
• 13:29
  to
• 13:29
  pick
• 13:29
  up
• 13:29
  popcorn
• 13:30
  without
• 13:31
  tremors.
• 13:31
  Now,
• 13:32
  because
• 13:32
  he's
• 13:33
  made
• 13:33
  things
• 13:33
  so
• 13:33
  difficult
• 13:34
  for
• 13:34
  their
• 13:34
  motor
• 13:34
  activity,
• 13:35
  they
• 13:35
  can't
• 13:35
  even
• 13:35
  hold
• 13:36
  the
• 13:36
  popcorn
• 13:36
  in
• 13:36
  their
• 13:36
  hand.
• 13:37
  They're
• 13:37
  having
• 13:37
  tremors
• 13:37
  and
• 13:38
  spilling
• 13:38
  it.
• 13:38
  They
• 13:38
  feel
• 13:39
  so
• 13:39
  restless
• 13:39
  in
• 13:39
  their
• 13:39
  seats,
• 13:40
  they
• 13:40
  need
• 13:40
  to
• 13:40
  jump
• 13:40
  out
• 13:41
  of
• 13:41
  them,
• 13:41
  and
• 13:41
  they
• 13:41
  feel
• 13:41
  really
• 13:42
  nervous.
• 13:42
  These
• 13:42
  are
• 13:42
  the
• 13:42
  EPS
• 13:43
  side
• 13:43
  effects
• 13:43
  we
• 13:43
  talk
• 13:44
  talk
• 13:44
  about.
• 13:44
  Now,
• 13:45
  Haldol
• 13:46
  did
• 13:46
  a
• 13:46
  number
• 13:46
  on
• 13:47
  the
• 13:47
  moviegoers
• 13:48
  with
• 13:48
  that
• 13:48
  first
• 13:48
  usher.
• 13:49
  The
• 13:49
  old
• 13:49
  school
• 13:50
  usher
• 13:50
  did
• 13:50
  a
• 13:50
  number
• 13:51
  on
• 13:51
  everybody.
• 13:51
  He
• 13:52
  calmed
• 13:52
  things
• 13:52
  down.
• 13:53
  But
• 13:53
  their
• 13:53
  motor
• 13:54
  side
• 13:54
  effects
• 13:54
  were
• 13:54
  really
• 13:55
  difficult
• 13:55
  in
• 13:56
  the
• 13:56
  movie
• 13:56
  theater.
• 13:56
  Very
• 13:57
  jittery,
• 13:58
  restless,
• 13:58
  stuck
• 13:59
  to
• 13:59
  their
• 13:59
  seats,
• 14:00
  just
• 14:00
  staring
• 14:00
  at
• 14:01
  the
• 14:01
  show.
• 14:01
  But
• 14:02
  again,
• 14:02
  Abilify
• 14:02
  is
• 14:03
  the
• 14:03
  smooth
• 14:03
  usher.
• 14:03
  Abilify
• 14:05
  often
• 14:05
  does
• 14:05
  cause
• 14:05
  aesthesia,
• 14:06
  right?
• 14:07
  But
• 14:07
  what
• 14:07
  Abilify
• 14:08
  does
• 14:08
  do
• 14:09
  is
• 14:09
  like
• 14:09
  the
• 14:09
  usher
• 14:10
  who
• 14:10
  says,
• 14:10
  okay,
• 14:10
  we're
• 14:10
  not
• 14:11
  going
• 14:11
  to
• 14:11
  put
• 14:11
  you
• 14:11
  in
• 14:11
  a
• 14:11
  straight
• 14:11
  jacket,
• 14:12
  but
• 14:12
  we're
• 14:12
  going
• 14:13
  to
• 14:13
  promote
• 14:13
  a
• 14:13
  little
• 14:13
  bit
• 14:13
  of
• 14:14
  movement.
• 14:14
  This
• 14:15
  is
• 14:15
  where
• 14:15
  the
• 14:15
  analogy
• 14:15
  gets
• 14:16
  a
• 14:16
  little
• 14:16
  slippery.
• 14:16
  So
• 14:16
  I'm
• 14:17
  not
• 14:17
  gonna.
• 14:17
  I'm
• 14:17
  not
• 14:17
  gonna
• 14:17
  take
• 14:18
  this,
• 14:18
  drive
• 14:18
  this
• 14:18
  home
• 14:18
  too
• 14:19
  much,
• 14:19
  but
• 14:19
  just
• 14:19
  know
• 14:19
  that
• 14:20
  Abilify
• 14:20
  doesn't
• 14:21
  completely
• 14:21
  block
• 14:22
  D2
• 14:22
  to
• 14:23
  the
• 14:23
  extent
• 14:23
  that
• 14:23
  Haldol
• 14:24
  does,
• 14:24
  but
• 14:24
  it,
• 14:25
  again,
• 14:25
  it's
• 14:25
  a
• 14:25
  partial
• 14:26
  agonist.
• 14:26
  So
• 14:26
  it
• 14:26
  stimulates
• 14:27
  a
• 14:27
  little
• 14:27
  bit.
• 14:28
  And
• 14:28
  so
• 14:28
  people
• 14:28
  have
• 14:29
  this
• 14:29
  kind
• 14:29
  of
• 14:29
  in
• 14:29
  between,
• 14:30
  like,
• 14:30
  should
• 14:30
  I
• 14:30
  get
• 14:30
  out
• 14:30
  of
• 14:30
  my
• 14:31
  chair?
• 14:31
  Should
• 14:31
  I
• 14:31
  not
• 14:31
  get
• 14:31
  out
• 14:32
  of
• 14:32
  my
• 14:32
  chair?
• 14:32
  I
• 14:32
  kind
• 14:32
  of
• 14:32
  wanna
• 14:32
  get
• 14:33
  out
• 14:33
  of
• 14:33
  my
• 14:33
  chair,
• 14:33
  but
• 14:33
  I'm
• 14:33
  not
• 14:33
  sure
• 14:34
  if
• 14:34
  I
• 14:34
  should
• 14:34
  get
• 14:34
  out
• 14:34
  of
• 14:34
  my
• 14:34
  chair.
• 14:35
  It's
• 14:35
  kind
• 14:35
  of
• 14:35
  like
• 14:36
  this
• 14:36
  dimmer
• 14:37
  switch,
• 14:37
  right?
• 14:37
  And
• 14:37
  that
• 14:37
  can
• 14:37
  make
• 14:38
  people
• 14:38
  very
• 14:38
  uncomfortable
• 14:39
  because
• 14:39
  they're
• 14:40
  not
• 14:40
  completely
• 14:40
  rigid
• 14:41
  and
• 14:41
  just
• 14:41
  not
• 14:41
  moving,
• 14:42
  or
• 14:43
  that
• 14:44
  muscle
• 14:44
  rigidity
• 14:44
  that's
• 14:45
  really
• 14:45
  intense,
• 14:45
  the
• 14:45
  intense
• 14:46
  blockade
• 14:46
  of
• 14:46
  D2.
• 14:47
  But
• 14:47
  it's
• 14:47
  kind
• 14:47
  of
• 14:47
  this
• 14:48
  weird
• 14:48
  middle
• 14:48
  ground,
• 14:48
  this
• 14:49
  purgatory
• 14:49
  in
• 14:49
  their
• 14:50
  motor
• 14:50
  system
• 14:50
  that
• 14:50
  can
• 14:51
  make
• 14:51
  them
• 14:51
  feel
• 14:52
  really
• 14:52
  restless,
• 14:53
  like
• 14:53
  they
• 14:53
  don't
• 14:53
  know
• 14:53
  which
• 14:53
  way
• 14:54
  they're
• 14:54
  really
• 14:54
  going.
• 14:54
  Okay,
• 14:55
  that's
• 14:55
  a
• 14:55
  different
• 14:56
  episode.
• 14:57
  But
• 14:57
  I
• 14:57
  do
• 14:57
  want
• 14:58
  to
• 14:58
  get
• 14:58
  back
• 14:58
  to
• 14:58
  these
• 14:58
  punk
• 14:59
  kids.
• 14:59
  They're
• 14:59
  thrown
• 15:00
  out
• 15:00
  around
• 15:01
  5ht2a
• 15:02
  or
• 15:02
  IL2a,
• 15:03
  and
• 15:04
  BAM.
• 15:05
  Because
• 15:05
  of
• 15:05
  that,
• 15:06
  people
• 15:06
  can
• 15:06
  move
• 15:06
  around
• 15:07
  a
• 15:07
  little
• 15:07
  bit
• 15:07
  more.
• 15:08
  And
• 15:09
  that's
• 15:09
  kind
• 15:09
  of
• 15:09
  a
• 15:09
  big
• 15:10
  win
• 15:10
  because
• 15:10
  if
• 15:11
  they
• 15:11
  have
• 15:11
  a
• 15:11
  bad
• 15:11
  usher,
• 15:12
  some
• 15:12
  movie
• 15:12
  nights,
• 15:13
  like,
• 15:13
  I
• 15:13
  don't
• 15:13
  want
• 15:14
  to
• 15:14
  say
• 15:14
  Haldahl's
• 15:14
  bad
• 15:15
  necessarily,
• 15:15
  actually.
• 15:16
  I
• 15:16
  just
• 15:16
  want
• 15:16
  to
• 15:17
  say
• 15:17
  Haldol
• 15:17
  strict,
• 15:18
  right?
• 15:18
  And
• 15:19
  not
• 15:19
  great
• 15:20
  for
• 15:20
  them
• 15:20
  in
• 15:21
  terms
• 15:21
  of
• 15:21
  their
• 15:21
  ability
• 15:21
  to
• 15:22
  move
• 15:22
  around
• 15:22
  the
• 15:22
  movie.
• 15:23
  Movie
• 15:23
  theater
• 15:23
  and,
• 15:24
  and
• 15:24
  move
• 15:25
  their
• 15:25
  hands,
• 15:25
  their
• 15:25
  legs,
• 15:26
  right?
• 15:26
  But
• 15:26
  if
• 15:26
  they
• 15:27
  are
• 15:27
  dealing
• 15:27
  with
• 15:27
  that
• 15:28
  old
• 15:28
  school
• 15:28
  usher,
• 15:29
  the
• 15:29
  last
• 15:30
  thing
• 15:30
  they're
• 15:30
  going
• 15:30
  to
• 15:30
  want
• 15:30
  is
• 15:31
  their
• 15:31
  feet
• 15:31
  are
• 15:31
  now
• 15:31
  stuck
• 15:32
  to
• 15:32
  the
• 15:32
  floor
• 15:33
  because
• 15:33
  of
• 15:33
  the
• 15:33
  soda
• 15:34
  that's
• 15:34
  spilled
• 15:34
  there,
• 15:35
  right?
• 15:35
  So
• 15:36
  Abilify
• 15:36
  goes,
• 15:36
  no
• 15:37
  more
• 15:37
  of
• 15:37
  that.
• 15:37
  We're
• 15:37
  gonna
• 15:37
  ease
• 15:38
  the
• 15:38
  burden
• 15:38
  on
• 15:39
  your
• 15:39
  movement
• 15:40
  and
• 15:40
  we're
• 15:40
  gonna
• 15:41
  throw
• 15:41
  these
• 15:41
  punk
• 15:41
  kids
• 15:42
  out
• 15:42
  of
• 15:42
  the
• 15:42
  movie
• 15:42
  theater,
• 15:43
  right?
• 15:43
  So
• 15:43
  that's
• 15:44
  pretty
• 15:44
  nice.
• 15:44
  Now
• 15:45
  I
• 15:45
  want
• 15:45
  you
• 15:45
  all
• 15:45
  to
• 15:46
  also
• 15:46
  think
• 15:47
  about
• 15:47
  5
• 15:48
  HT2C
• 15:49
  receptors,
• 15:49
  which
• 15:50
  can
• 15:50
  be
• 15:50
  typically
• 15:50
  implicated
• 15:51
  in
• 15:51
  weight
• 15:52
  gain.
• 15:52
  Now
• 15:52
  for
• 15:52
  this
• 15:52
  analogy,
• 15:53
  I
• 15:53
  want
• 15:53
  you
• 15:53
  to
• 15:53
  think
• 15:54
  of
• 15:54
  the
• 15:55
  normal
• 15:55
  way
• 15:55
  of
• 15:55
  business
• 15:56
  is
• 15:57
  you
• 15:57
  have
• 15:57
  two
• 15:58
  cashiers
• 15:58
  running
• 15:59
  the
• 15:59
  snack
• 15:59
  kiosk
• 16:00
  in
• 16:00
  the
• 16:00
  back
• 16:00
  of
• 16:01
  the
• 16:01
  movie
• 16:01
  theater.
• 16:01
  They
• 16:01
  usually
• 16:02
  limit
• 16:02
  everybody
• 16:02
  to
• 16:03
  like
• 16:03
  one
• 16:03
  bucket
• 16:03
  of
• 16:03
  popcorn,
• 16:05
  one
• 16:05
  beer
• 16:05
  a
• 16:05
  piece,
• 16:06
  and
• 16:06
  that's
• 16:06
  really
• 16:06
  it.
• 16:07
  So
• 16:07
  everybody
• 16:07
  normally
• 16:08
  just
• 16:08
  kind
• 16:08
  of
• 16:08
  gets
• 16:09
  a
• 16:09
  snack
• 16:09
  and
• 16:09
  goes.
• 16:10
  Or
• 16:10
  maybe
• 16:10
  they
• 16:10
  don't
• 16:10
  choose
• 16:11
  to
• 16:11
  get
• 16:11
  snacks.
• 16:12
  And
• 16:12
  people
• 16:13
  eat
• 16:13
  and
• 16:13
  enjoy
• 16:14
  the
• 16:14
  movie.
• 16:15
  Now
• 16:15
  with
• 16:15
  a
• 16:16
  medication
• 16:16
  like
• 16:16
  Zyprexa,
• 16:17
  imagine
• 16:18
  Zyprexa
• 16:19
  is
• 16:19
  an
• 16:19
  usher
• 16:19
  that
• 16:19
  basically
• 16:20
  comes
• 16:20
  in
• 16:20
  and
• 16:20
  goes,
• 16:21
  all
• 16:21
  right,
• 16:22
  you
• 16:22
  two
• 16:22
  cashiers
• 16:23
  manning
• 16:23
  the
• 16:23
  snack
• 16:23
  kiosk,
• 16:24
  you
• 16:24
  can
• 16:24
  go
• 16:24
  on
• 16:25
  a
• 16:25
  break
• 16:25
  at
• 16:25
  the
• 16:25
  same
• 16:25
  time.
• 16:26
  Go
• 16:26
  have
• 16:27
  some
• 16:27
  fun.
• 16:27
  And
• 16:28
  now
• 16:28
  nobody's
• 16:28
  manning
• 16:29
  the
• 16:29
  snack
• 16:29
  kiosk.
• 16:30
  And
• 16:30
  so
• 16:30
  the
• 16:31
  moviegoers
• 16:31
  come
• 16:32
  in
• 16:32
  and
• 16:32
  they
• 16:32
  just
• 16:32
  loot
• 16:32
  it.
• 16:33
  And
• 16:33
  rate
• 16:33
  it.
• 16:33
  And
• 16:33
  they
• 16:34
  eat
• 16:34
  all
• 16:34
  the
• 16:34
  popcorn,
• 16:34
  the
• 16:35
  twizzlers,
• 16:35
  the
• 16:35
  snow
• 16:35
  caps,
• 16:36
  the
• 16:36
  M&Ms.
• 16:37
  They're
• 16:38
  drizzling
• 16:38
  caramel
• 16:39
  everywhere
• 16:39
  into
• 16:39
  their
• 16:39
  mouths.
• 16:40
  They
• 16:40
  just
• 16:40
  go
• 16:40
  haywire.
• 16:41
  And
• 16:41
  they
• 16:41
  gain
• 16:42
  tons
• 16:42
  of
• 16:42
  weight
• 16:42
  because
• 16:43
  the
• 16:43
  usher
• 16:43
  antagonized
• 16:44
  the
• 16:44
  cashiers,
• 16:45
  threw
• 16:45
  them
• 16:46
  out,
• 16:46
  and
• 16:46
  said,
• 16:46
  go
• 16:47
  to
• 16:47
  lunch.
• 16:47
  Go
• 16:47
  to
• 16:47
  lunch
• 16:48
  right
• 16:48
  now.
• 16:49
  And
• 16:49
  they
• 16:49
  antagonize
• 16:50
  them
• 16:50
  so
• 16:50
  badly
• 16:51
  and
• 16:52
  so
• 16:52
  heavily
• 16:52
  that
• 16:53
  it's
• 16:53
  a
• 16:53
  free
• 16:53
  for
• 16:54
  all
• 16:54
  at
• 16:54
  2C.
• 16:55
  And
• 16:55
  you
• 16:55
  can
• 16:55
  think
• 16:55
  of
• 16:55
  C
• 16:56
  as
• 16:56
  cashiers.
• 16:57
  The
• 16:57
  two
• 16:57
  cashiers
• 16:58
  2C
• 16:59
  were
• 16:59
  thrown
• 17:00
  out,
• 17:01
  and
• 17:02
  because
• 17:02
  of
• 17:02
  that,
• 17:02
  it's
• 17:02
  a
• 17:03
  free
• 17:03
  for
• 17:03
  all.
• 17:03
  Nobody's
• 17:04
  attending
• 17:04
  the
• 17:04
  kiosk,
• 17:05
  and
• 17:05
  all
• 17:05
  the
• 17:05
  moviegoers
• 17:06
  are
• 17:06
  just
• 17:06
  looting
• 17:06
  all
• 17:06
  the
• 17:07
  popcorn
• 17:07
  and
• 17:07
  gaining
• 17:07
  tons
• 17:07
  of
• 17:08
  weight.
• 17:08
  Now
• 17:08
  Abilify
• 17:09
  is
• 17:09
  more
• 17:10
  of
• 17:10
  a
• 17:10
  weak
• 17:10
  antagonist.
• 17:11
  So
• 17:11
  he
• 17:11
  don't
• 17:11
  Abilify.
• 17:12
  The
• 17:12
  usher
• 17:12
  walks
• 17:12
  up
• 17:13
  to
• 17:13
  the
• 17:13
  2C
• 17:14
  kiosk
• 17:15
  and
• 17:15
  goes,
• 17:15
  how
• 17:15
  about
• 17:15
  one
• 17:16
  of
• 17:16
  you
• 17:16
  go
• 17:16
  on
• 17:16
  a
• 17:16
  break,
• 17:17
  right?
• 17:17
  And
• 17:18
  the
• 17:18
  other
• 17:18
  one
• 17:18
  still
• 17:18
  gets
• 17:19
  to
• 17:19
  ring
• 17:19
  people
• 17:19
  up,
• 17:20
  but
• 17:20
  now
• 17:20
  there's
• 17:20
  one
• 17:21
  less
• 17:21
  guy
• 17:21
  kind
• 17:21
  of
• 17:22
  watching
• 17:22
  the
• 17:23
  front
• 17:23
  desk?
• 17:23
  And
• 17:24
  so
• 17:24
  people
• 17:24
  kind
• 17:24
  of
• 17:24
  steal
• 17:25
  a
• 17:25
  bucket
• 17:25
  of
• 17:25
  popcorn
• 17:26
  or
• 17:26
  two.
• 17:27
  Some
• 17:27
  M&Ms.
• 17:28
  Notice
• 17:29
  how
• 17:29
  he's
• 17:29
  never
• 17:29
  too
• 17:29
  extreme
• 17:30
  in
• 17:30
  either
• 17:30
  direction.
• 17:31
  It's
• 17:32
  more
• 17:32
  of
• 17:32
  a
• 17:32
  dimmer
• 17:32
  switch
• 17:33
  everywhere
• 17:33
  it
• 17:33
  goes.
• 17:34
  But
• 17:34
  it
• 17:34
  antagonizes
• 17:35
  5ht,
• 17:36
  2c.
• 17:36
  So
• 17:36
  folks
• 17:37
  are
• 17:37
  possibly
• 17:37
  gaining
• 17:38
  weight,
• 17:38
  but
• 17:38
  not
• 17:39
  to
• 17:39
  the
• 17:39
  extent
• 17:39
  that
• 17:39
  they
• 17:39
  would
• 17:39
  with
• 17:40
  Zyprexa.
• 17:40
  I
• 17:40
  want
• 17:41
  you
• 17:41
  all
• 17:41
  to
• 17:42
  appreciate
• 17:43
  the
• 17:43
  complexity
• 17:44
  and
• 17:44
  nuance
• 17:45
  of
• 17:45
  the
• 17:45
  medications
• 17:45
  you
• 17:46
  prescribe.
• 17:46
  I
• 17:47
  hope
• 17:47
  this
• 17:47
  analogy
• 17:47
  helped
• 17:48
  further
• 17:48
  your
• 17:48
  understanding
• 17:49
  and
• 17:49
  appreciation
• 17:50
  of
• 17:51
  these
• 17:51
  medications,
• 17:52
  because
• 17:52
  notice
• 17:52
  how
• 17:53
  there's
• 17:53
  many
• 17:53
  sections
• 17:53
  of
• 17:54
  the
• 17:54
  movie
• 17:54
  theater
• 17:55
  and
• 17:55
  there's
• 17:55
  many
• 17:55
  ways
• 17:56
  by
• 17:56
  which
• 17:56
  you
• 17:56
  can
• 17:56
  contain
• 17:57
  the
• 17:58
  chaos
• 17:58
  and
• 17:58
  make
• 17:59
  for
• 17:59
  a
• 17:59
  more
• 17:59
  optimal
• 18:00
  experience
• 18:01
  in
• 18:01
  watching
• 18:02
  the
• 18:02
  movies.
• 18:02
  Right?
• 18:03
  There's
• 18:03
  many
• 18:03
  different
• 18:04
  aisles
• 18:04
  or
• 18:04
  receptor
• 18:05
  targets,
• 18:06
  right?
• 18:06
  And
• 18:07
  those
• 18:07
  aisles
• 18:07
  are
• 18:08
  behaving
• 18:08
  in
• 18:08
  certain
• 18:09
  ways
• 18:09
  that
• 18:10
  affect
• 18:10
  other
• 18:10
  aisles.
• 18:11
  Right?
• 18:11
  And
• 18:11
  they
• 18:12
  also
• 18:12
  affect
• 18:13
  a
• 18:13
  lot
• 18:13
  of
• 18:13
  other
• 18:13
  downstream
• 18:15
  conditions.
• 18:15
  We
• 18:15
  saw
• 18:16
  how
• 18:16
  serotonin
• 18:16
  can
• 18:17
  dampen
• 18:17
  dopamine
• 18:18
  when
• 18:18
  it's
• 18:19
  dysregulated.
• 18:19
  You
• 18:20
  have
• 18:20
  to
• 18:20
  go
• 18:20
  in
• 18:20
  there
• 18:21
  and
• 18:21
  finesse
• 18:21
  things.
• 18:22
  And
• 18:22
  that's
• 18:22
  what
• 18:22
  Abilify
• 18:23
  or
• 18:23
  this
• 18:23
  usher
• 18:23
  was
• 18:24
  able
• 18:24
  to
• 18:24
  do.
• 18:24
  He
• 18:24
  went
• 18:24
  into
• 18:24
  various
• 18:25
  aisles
• 18:25
  and
• 18:26
  worked
• 18:26
  things
• 18:27
  out
• 18:27
  in
• 18:28
  different
• 18:28
  areas
• 18:28
  to
• 18:29
  where
• 18:29
  everybody's
• 18:30
  movie
• 18:30
  experience
• 18:30
  was
• 18:31
  a
• 18:31
  little
• 18:31
  bit
• 18:31
  better.
• 18:32
  He
• 18:32
  didn't
• 18:32
  completely
• 18:33
  shut
• 18:33
  down
• 18:33
  the
• 18:34
  show
• 18:34
  like
• 18:34
  the
• 18:34
  Haldahl
• 18:35
  usher,
• 18:35
  right?
• 18:36
  Because
• 18:36
  Haldol
• 18:36
  kind
• 18:36
  of
• 18:37
  completely
• 18:37
  shuts
• 18:37
  the
• 18:38
  show
• 18:38
  down.
• 18:38
  There's
• 18:39
  not
• 18:39
  a
• 18:39
  lot
• 18:39
  of
• 18:39
  movement.
• 18:40
  There's
• 18:40
  not
• 18:40
  a
• 18:40
  lot
• 18:40
  of
• 18:40
  laughing.
• 18:41
  There's
• 18:41
  not
• 18:41
  a
• 18:41
  lot
• 18:41
  of
• 18:41
  this
• 18:42
  or
• 18:42
  that.
• 18:42
  But
• 18:42
  Abilify
• 18:43
  went
• 18:43
  In
• 18:43
  there,
• 18:43
  he
• 18:44
  was
• 18:44
  kind
• 18:44
  of
• 18:44
  a
• 18:44
  more
• 18:44
  gentle
• 18:45
  usher
• 18:45
  and
• 18:46
  he
• 18:46
  toned
• 18:46
  everything
• 18:47
  down
• 18:47
  pretty
• 18:48
  nicely.
• 18:48
  Right,
• 18:49
  because
• 18:49
  there
• 18:49
  was
• 18:49
  still
• 18:49
  noise
• 18:49
  in
• 18:50
  the
• 18:50
  movie
• 18:50
  theater.
• 18:50
  Right?
• 18:50
  There
• 18:51
  was
• 18:51
  still
• 18:51
  some
• 18:51
  laughing,
• 18:52
  maybe
• 18:52
  a
• 18:52
  couple
• 18:52
  people
• 18:53
  throw
• 18:53
  some
• 18:53
  popcorn.
• 18:54
  And
• 18:54
  so
• 18:54
  you
• 18:54
  have
• 18:54
  the
• 18:54
  possibility
• 18:55
  to
• 18:55
  induce
• 18:55
  mania.
• 18:56
  And
• 18:56
  that's
• 18:57
  another
• 18:57
  podcast
• 18:57
  episode,
• 18:58
  but
• 18:59
  you
• 18:59
  have
• 18:59
  that
• 18:59
  possibility
• 19:00
  to
• 19:00
  induce
• 19:00
  mania.
• 19:02
  But
• 19:03
  you
• 19:03
  know,
• 19:04
  something
• 19:05
  to
• 19:05
  think
• 19:05
  about
• 19:05
  because
• 19:06
  we're
• 19:06
  not
• 19:06
  completely
• 19:07
  blocking
• 19:08
  dopamine
• 19:09
  with
• 19:09
  Abilify.
• 19:10
  And
• 19:10
  there's
• 19:11
  so
• 19:11
  many
• 19:11
  more
• 19:11
  nuances
• 19:11
  where
• 19:12
  this
• 19:12
  comes
• 19:12
  from.
• 19:12
  I'd
• 19:13
  love
• 19:13
  to
• 19:13
  hear
• 19:13
  all
• 19:13
  your
• 19:13
  thoughts
• 19:14
  on
• 19:14
  this.
• 19:15
  If
• 19:15
  you
• 19:15
  go
• 19:15
  to
• 19:15
  the
• 19:15
  Show
• 19:15
  Notes,
• 19:16
  you
• 19:16
  can
• 19:16
  email
• 19:16
  me
• 19:16
  more
• 19:17
  of
• 19:17
  your
• 19:17
  thoughts
• 19:17
  or
• 19:17
  even
• 19:18
  analogies
• 19:19
  to
• 19:19
  describe
• 19:19
  this
• 19:20
  stuff.
• 19:20
  I'm
• 19:20
  a
• 19:20
  sucker
• 19:20
  for
• 19:21
  analogies.
• 19:21
  I
• 19:21
  love
• 19:21
  them.
• 19:22
  And
• 19:22
  so
• 19:22
  if
• 19:22
  you
• 19:22
  all
• 19:23
  could
• 19:23
  get
• 19:23
  into
• 19:23
  the
• 19:24
  Show
• 19:24
  Notes
• 19:24
  and
• 19:24
  email
• 19:24
  me,
• 19:25
  I
• 19:25
  would
• 19:25
  love
• 19:25
  to
• 19:25
  hear
• 19:26
  more
• 19:26
  of
• 19:26
  your
• 19:26
  thoughts
• 19:26
  about
• 19:27
  how
• 19:27
  you
• 19:27
  conceptualize
• 19:28
  this
• 19:28
  or
• 19:28
  maybe
• 19:28
  things
• 19:29
  that
• 19:29
  still
• 19:29
  confuse
• 19:30
  you
• 19:30
  or
• 19:31
  medications.
• 19:31
  You
• 19:32
  want
• 19:32
  us
• 19:32
  to
• 19:32
  do
• 19:32
  a
• 19:32
  deep
• 19:32
  dive
• 19:33
  on
• 19:33
  our
• 19:33
  off
• 19:33
  the
• 19:34
  Farm
• 19:34
  series?
• 19:34
  Now
• 19:35
  a
• 19:35
  lot
• 19:35
  of
• 19:35
  these
• 19:35
  off
• 19:35
  the
• 19:36
  Farm
• 19:36
  series
• 19:36
  are
• 19:37
  going
• 19:37
  to
• 19:37
  be
• 19:37
  published
• 19:38
  on
• 19:38
  our
• 19:39
  Patreon
• 19:40
  page.
• 19:41
  If
• 19:41
  you
• 19:41
  become
• 19:41
  a
• 19:41
  member,
• 19:41
  you
• 19:42
  will
• 19:42
  have
• 19:42
  access
• 19:42
  to
• 19:43
  off
• 19:43
  the
• 19:43
  Farm
• 19:44
  bonus
• 19:44
  episodes,
• 19:45
  a
• 19:45
  private
• 19:45
  podcast
• 19:46
  feed.
• 19:47
  In
• 19:47
  addition
• 19:47
  to
• 19:48
  tons
• 19:48
  of
• 19:48
  beautiful
• 19:49
  slide
• 19:49
  decks
• 19:49
  full
• 19:50
  of
• 19:50
  this
• 19:50
  information.
• 19:51
  Go
• 19:51
  buys
• 19:52
  rich
• 19:52
  clinical
• 19:52
  tools
• 19:53
  to
• 19:53
  empower
• 19:53
  you
• 19:54
  and
• 19:54
  your
• 19:54
  confidence
• 19:54
  in
• 19:55
  your
• 19:55
  practice.
• 19:56
  That's
• 19:56
  what
• 19:56
  we
• 19:56
  want.
• 19:57
  I
• 19:57
  can't
• 19:58
  emphasize
• 19:58
  enough
• 19:58
  how
• 19:58
  important
• 19:59
  it
• 19:59
  is
• 19:59
  to
• 19:59
  become
• 19:59
  a
• 19:59
  Patreon
• 20:00
  member
• 20:00
  to
• 20:01
  have
• 20:01
  access
• 20:02
  to
• 20:02
  these
• 20:03
  resources
• 20:03
  to
• 20:04
  kind
• 20:04
  of
• 20:04
  further
• 20:04
  your
• 20:05
  experience.
• 20:05
  This
• 20:06
  podcast
• 20:06
  has
• 20:06
  gotten
• 20:07
  very
• 20:07
  big
• 20:07
  very
• 20:07
  fast.
• 20:08
  We're
• 20:09
  very
• 20:09
  fortunate
• 20:09
  for
• 20:09
  all
• 20:09
  of
• 20:10
  the
• 20:10
  folks,
• 20:10
  especially
• 20:10
  in
• 20:11
  Psych
• 20:11
  NP
• 20:11
  School,
• 20:12
  who
• 20:12
  have
• 20:12
  been
• 20:12
  able
• 20:12
  to
• 20:12
  share
• 20:12
  this
• 20:13
  with
• 20:13
  their
• 20:13
  cohorts
• 20:14
  and
• 20:14
  make
• 20:14
  better
• 20:14
  sense
• 20:15
  of
• 20:15
  what's
• 20:15
  going
• 20:15
  on.
• 20:16
  It's
• 20:16
  a
• 20:16
  playful
• 20:17
  way
• 20:17
  to
• 20:17
  do
• 20:17
  it.
• 20:17
  We
• 20:17
  like
• 20:18
  to
• 20:18
  have
• 20:18
  fun
• 20:18
  when
• 20:18
  we
• 20:18
  learn.
• 20:19
  Keep
• 20:19
  the
• 20:19
  love
• 20:20
  coming.
• 20:20
  And
• 20:20
  if
• 20:20
  nothing
• 20:21
  else,
• 20:21
  please
• 20:21
  go
• 20:21
  to
• 20:21
  Apple
• 20:22
  today
• 20:23
  at
• 20:23
  some
• 20:23
  point
• 20:23
  and
• 20:24
  rate
• 20:24
  our
• 20:24
  podcast
• 20:25
  five
• 20:25
  stars.
• 20:25
  It
• 20:26
  really
• 20:26
  helps
• 20:26
  if
• 20:26
  we've
• 20:27
  earned
• 20:27
  your
• 20:27
  five
• 20:28
  star
• 20:28
  rating.
• 20:28
  Please
• 20:28
  go
• 20:29
  to
• 20:29
  Apple
• 20:29
  and
• 20:29
  rate
• 20:29
  us
• 20:30
  and
• 20:30
  we'll
• 20:31
  be
• 20:31
  happy
• 20:31
  to
• 20:31
  keep
• 20:32
  churning
• 20:32
  these
• 20:32
  out
• 20:32
  for
• 20:33
  you
• 20:33
  if
• 20:33
  you
• 20:33
  become
• 20:33
  a
• 20:34
  Patreon
• 20:34
  member.
• 20:34
  Really
• 20:35
  helps
• 20:35
  us
• 20:35
  get
• 20:36
  you
• 20:36
  more
• 20:37
  pearls
• 20:38
  and
• 20:38
  ways
• 20:39
  you
• 20:39
  can
• 20:39
  succeed
• 20:40
  every
• 20:40
  day
• 20:40
  in
• 20:40
  your
• 20:40
  practice.
• 20:41
  Thanks
• 20:41
  again
• 20:41
  for
• 20:42
  tuning
• 20:42
  in
• 20:43
  and
• 20:43
  we
• 20:43
  will
• 20:43
  see
• 20:43
  you
• 20:44
  next
• 20:44
  time,
• 20:44
  my
• 20:44
  friends.
• 20:45
  Bye
• 20:45
  Bye.