PsychRounds: The Psychiatry Podcast Schizophrenia: Antipsychotics with Dr. Jason Cafer
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Aug 14, 2024 Dr. Jason Cafer, an assistant professor of psychiatry and author of Cafer's Psychopharmacology, shares his expertise on antipsychotics and schizophrenia. He emphasizes the significance of choosing the right medication based on individual patient needs and the unique properties of clozapine for treatment-resistant cases. The discussion also covers the pharmacological mechanisms of antipsychotics, including marketing influences and the complexities of loxapine. Cafer advocates for improved education on prescribing practices to enhance patient outcomes.
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Typical vs Atypical: Marketing Spin
- The typical versus atypical antipsychotic distinction is mostly a marketing concept rather than a scientific categorization.
- Clozapine and some atypicals are unique, but overall, the difference is more about side effect profiles than fundamental efficacy.
Three Antipsychotic Categories
- Antipsychotics can be grouped into three categories: D2 partial agonists, clozapine alone, and all other D2 blockers.
- Each category has distinct mechanisms influencing efficacy and side effect profiles like tardive dyskinesia.
Clozapine's Unique Mechanism
- Clozapine is uniquely effective, decreasing mortality by 44% and benefiting about half of treatment-resistant schizophrenia cases.
- It works through mechanisms beyond D2 blockade, such as NMDA receptor interaction and strong 5-HT2A antagonism.