PsychEd Episode 62: Antipsychotic Side Effects with Dr. Alex Raben

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Antipsychotic Side Effects with our very own expert Dr Alex Raben, a staff psychiatrist in chronic care at the Centre for Addiction and Mental Health in Toronto.

Dr. Raben graduated from medical school and completed residency at the University of Toronto. His academic interests include teaching and medical education scholarship with a particular interest in novel modalities of knowledge translation within the field of psychiatry. He is a founding member and Executive Director of PsychEd, this educational psychiatry podcast which aims to empower medical learners to seek out current knowledge from mental health experts to share with their colleagues around the world.

The learning objectives for this episode are as follows:

By the end of this episode, the listener will be able to…

1. Outline the side effects of antipsychotics and their known/potential mechanisms
2. Discuss management options for the different side effects
3. Identify which antipsychotics are more likely to cause certain side effects

Guest: Dr Alex Raben

Hosts: Angad Singh and Kate Braithwaite

Audio editing by: Angad Singh

Show notes by: Angad Singh and Kate Braithwaite

Interview Content:

• Introduction - 0:00
• Primer on antipsychotics - 1:54
• Anti-dopamine side effects - 5:04
• Drug potency as it relates to side effects - 38:46
• Anticholinergic side effects - 41:37
• Antiadrenergic side effects - 47:30
• Metabolic side effects - 50:29
• Sedation - 56:46

Please note that this episode does not include a discussion of the life threatening side effects of antipsychotics. These include neuroleptic malignant syndrome, torsades de pointes, laryngospasm, and seizure.

Resources:

• PsychEd Episode 10: Treatment of Schizophrenia Part II with Dr. Albert Wong — PsychEd Podcast
• PsychEd Episode 60: Metabolic Psychiatry with Dr. Cindy Calkin – Psyched Podcast
• AIMSExtendedSample - YouTube
• Anticholinergic Mnemonics: Toxicology Mnemonic Challenge • LITFL • Toxicology Conundrum

References:

• de Silva VA, Suraweera C, Ratnatunga SS, Dayabandara M, Wanniarachchi N, Hanwella R. Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis. BMC psychiatry. 2016;16:1-0.
• Migirov A, Datta AR. Physiology, Anticholinergic Reaction. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546589/
• Miller DD. Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):3-7. PMID: 16001094; PMCID: PMC487011.
• Roerig JL, Steffen KJ, Mitchell JE. Atypical antipsychotic-induced weight gain: insights into mechanisms of action. CNS drugs. 2011;25:1035-59.
• Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press; 2021.
• Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17(3):341-56.

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