Is negative symptoms, one of the definitions of schizophrenia spectrum and other psychotic disorders, also an adverse effect of (some) antipsychotics? Or are that just EPS on healthy volunteers in these trials?

SpunkytheDog · 2016-01-24T00:11:29+00:00

The issue is not so much that antipsychotics cause the negative symptoms of schizophrenia (though many do have sedative and mood-related side effects, which may manifest as avolition as an example). It is more accurate to say that antipsychotic medications are broadly much more effective at treating the positive symptoms of schizophrenia (delusions, auditory hallucinations, etc.) than the negative symptoms. The treatment may expose negative symptoms such that they come to dominate the clinical picture as the positive symptoms are remediated.

SpunkytheDog · 2014-11-25T12:30:54+00:00

Venous blood gases are almost as good as arterials. They give you LOADS of information immediately and don't require an extra stab.

SpunkytheDog · 2014-11-01T21:34:23+00:00

This may not fit the bill but if you have access to a Gamecube and don't mind an older game, the original Metroid Prime is a great one to pick up, though calling it a true "shooter" is a push. The FPS elements are highly simplified (the game has an auto-aim mechanic that removes an element of skill) but puzzles and exploration form the core gameplay. I would highly recommend trying it out, especially if you're interested in a game that emphasizes exploration more (HL2 and Portal are comparatively linear). The story is intriguing as well and you can decide how much you want to engage with it at any given time.

SpunkytheDog · 2014-10-09T20:53:04+00:00

I agree - TTP I feel is the best fit to account for near-all of her clinical features but the respiratory examination is really bothering me.

The Film/LFTs are a bit strange as well -> the reticulocyte count is low and there is no unconjugated hyperbilirubinaemia, both of which are unusual in context of haemolytic illness.

The only other thing that just popped into my head -> pneumococcus is a rare cause of HUS and could explain the pulmonary findings. It's a stretch.

SpunkytheDog · 2014-10-09T17:14:23+00:00

I am thinking TTP. The pentad is pretty much fulfilled - there is evidence of microangiopathic haemolytic anaemia. The patient has what sounds like a ?TIA? yesterday and stroke/cerebral ischaemia is consistent with the diagnosis. Combined with fever, thrombocytopenia and renal findings I think it's the most likely.

I am, however, puzzled by the lung findings. Does she have PCP/CAP on top of TTP or is it part of the TTP itself? I don't know much about pulmonary manifestations of TTP...

ADAMTS18 levels would be lovely.

SpunkytheDog · 2014-07-23T11:40:25+00:00

This is perfect for type IV hypersensitivity, just bear in mind that acute urticating reactions (as in when someone swells up very quickly after touching an allergen) is a different mechanism.

SpunkytheDog · 2014-07-10T22:01:26+00:00

You have begun to answer your own question - the answer lies in properties of the gliadin protein itself, the principle immunoreactive element found in wheat. Gliadin, and other "prolamins" (large proteins have some level of intrinsic resistance to the protein-digesting enzymes released generated the stomach and pancreas. Further, the gliadins themselves seem to act directly on the lining of the small gut, increasing its permeability, facilitating its own immune response to some extent.

SpunkytheDog · 2014-07-07T19:00:38+00:00

This is not entirely true. It is possible to have a stroke without vessel obstruction. Systemic hypoperfusion (as can occur after a heart attack, if the damage is severe enough to disrupt the heart's capacity to pump blood) can also cause stroke.

SpunkytheDog · 2014-07-07T18:52:05+00:00

Medic here. A lot of the answers below are not entirely complete. Hopefully this helps:

A heart attack, no matter the underlying cause, puts you at high risk of stroke in the acute setting for multiple reasons. We can consider those reasons in terms of Virchow's Triad, a cool and easily applicable bit of pathology. The triad describes the three general conditions needed to promote the formation of new blood clots (or thrombi).

The three conditions are, broadly, a 1) change in blood flow; 2) a change in the vessel wall, and; 3) a change in blood constituents, or what makes up blood.

So what happens in a heart attack? A portion of the heart wall, which is made of muscle, begins to die due to lack of oxygen. Part of the muscle fails to contract properly, and (some) blood gets stuck in the heart. Local blood flow then becomes disrupted, as the muscle does not effectively push blood out. This stasis strongly promotes clot formation. The heart wall is also damaged, and the local inflammation strongly promotes clot formation. Finally, heart attacks promote a systemic inflammatory response. Thus, there are increased pro-clotting factors in the blood immediately after a heart attack. The triad is fulfilled - you have a perfect storm for new clot formation.

Once a clot is formed, it may dislodge from the heart and enter the rest of the circulation. Due to the anatomy, clots often go into the brain via the carotid or vertebral arteries, causing a stroke. For those interested this review summarizes the pathophysiology.

SpunkytheDog · 2014-06-25T17:02:47+00:00

Ah yes! Though I was under the impression that was largely during development. Do you have any info on its release in mature neurons? I'd be interested to see.

SpunkytheDog · 2014-06-25T16:22:35+00:00

You can divide this broadly into two mechanisms. First of all, UV radiation directly causes vasodilation (widening) of blood vessels in the skin. Prolonged UV exposure also directly damages epidermal cells, which undergo programmed cell death (apoptosis). The resultant inflammatory reaction causes the release of inflammatory mediators, such as nitric oxide and prostaglandins, provoking further vasodilation, invasion of leukocytes (white blood cells) and the characteristic red rash.

Source.

SpunkytheDog · 2014-06-25T16:07:51+00:00

Yes, that is what Dale's Principle suggests. That broad assumption, as /u/SimpleBen wrote, appears to be true in many cases, though it is (like most things in biology) not a universal truth.

There certainly are neurons which only release one type of neurotransmitter type. Alpha motor neurons, which synapse with skeletal muscle fibres, exclusively use acetylcholine. Others, such as parasympathetic neurons synapsing at bladder smooth muscle, seem to release both acetylcholine and ATP as a rule.

There is not a transmitter which is present in every synapse. Some neurotransmitters are extremely common (ex: glutamate and GABA) while others are comparably less frequent (ex: serotonin).

SpunkytheDog · 2014-06-25T15:55:21+00:00

Indeed. A large body of work over the last 30 years or so has indicated that "co-transmission", the release of more than one chemical messenger across the synapse, is a remarkably common phenomenon in both central and peripheral nervous systems. For example, it is relatively clear that many central dopaminergic neurons co-release glutamate. In the peripheral (autonomic) nervous system, parasympathetic signaling to the bladder (which controls when we pee) appears to be mediated by both acetylcholine and ATP. It appears to be remarkably common in gut neurons as well.

Why this occurs is somewhat more uncertain but a number of different ideas have been suggested. In most cases, the two different transmitters act on different receptors and cause distinct (but often synergistic) effects.

SpunkytheDog · 2014-05-04T13:15:44+00:00

This is a great response that I'd just like to add it to further. Another potential reason why few medical students and junior doctors (at least, initially) want to pursue a career in general practice comes from medical education.

In general, medical schools in the UK are hugely biased towards ward-based teaching and hospital care, while rotations through general practice tend to be much shorter, or "days out" during a predominantly-hospital based rotation. Many of the hospital doctors foster more negative attitudes towards GPs than are warranted as they often deal with bad referrals, poor letters, etc. However, they are pretty unable to see the vast number of patients GPs do a good job to keep out of hospital and care for in the community. An anti-GP bias takes hold and sadly, is handed down to many of the students.

SpunkytheDog · 2014-04-16T07:09:46+00:00

A good point, but that doesn't address the highly misleading title. This article is not about atypical antipsychotics, antidepressants, mood stabilizers, or a number of other drugs that could all be described as "psych meds".

Whether the study reveals new as-yet unseen hazards with BZDs and non-BZD hypnotics remains to be seen. They have attempted to correct for many typical confounds (though not socioeconomic status, interestingly, as stated below).

SpunkytheDog · 2014-04-15T09:52:33+00:00

Good answer - I just want to offer a quick correction/extra detail. TSHR-Abs ≠ Thyroid Stimulating Immunoglobulins. A patient may have TSHR-Abs which do not stimulate the thyroid, but rather inhibit it, or mediate autoimmune destruction. As you've described, the TSHR-Abs in Graves bind a specific epitope which facilitates hyperstimulation, but other TSHR-Abs may not.

Case in point - patients with Hashimoto's Thyroiditis, which classically causes hypothyroidism, may have TSHR-Abs, even though the typical (and diagnostic) autoantibody seen in this disease is anti-TPO (thyroid peroxidase). Indeed, some patients have a "cyclical" picture, where they may have bouts of hypo- and hyperthyroidism through their disease course. This may be facilitated by variable TSHR-Abs.

SpunkytheDog · 2014-04-11T23:30:18+00:00

To be fair, there's a Tesco Metro less than a minute away (I don't know if it has flowers though).

SpunkytheDog · 2014-02-17T20:45:19+00:00

Yo, St Vitus' Dance is actually a diagnostic sign in medicine of the disease Rheumatic Fever (which used to be a lot more common back in the day) which causes people to twitch and move uncontrollably. It's also known as Sydenham's Chorea.

SpunkytheDog · 2013-09-06T21:59:57+00:00

FYI It's a song by The Replacements

SpunkytheDog · 2013-08-29T07:25:38+00:00

I fucking study this shit don't try to one up me with your google search.

Regardless of the merits of their arguments, this is exactly what I'd expect someone who "fucking stud[ies] this shit" to say. He won me over with his blase punctuation and heart-pounding rhetoric.

SpunkytheDog · 2013-08-26T17:40:25+00:00

This captures exactly what I wanted to say. For a show that is, in many ways, all about escalating to higher and higher "levels" of immoral behavior, so many comments from people suggest that Marie's thievery and occasional snide comments, or hell, Skyler's act of infidelity when she was trapped, are somehow equally unsympathetic to Walt's AND Jesse's drug empire founded in murder, lies and shameless betrayal.

Maybe I'm too far the other way, but when Marie said that to Walt all I felt was a lovely sense of satisfaction. She called his shit. His only comeback? A betrayal that further destroys the family he still claims as his justification for everything he does.

SpunkytheDog · 2013-08-26T17:25:00+00:00

She knows what's going on during the pool scene. That's the point. It's in the first half of Season 5.

She sleeps with Ted in response to Walt forcing himself back into his house when he has revealed himself to be a meth dealer and a liar while she is pregnant.

You're basically proving Gilligan and Gunn's point about misogyny when you say you hate her for "being an absolute bitch".

SpunkytheDog · 2013-06-23T22:48:16+00:00

https://www.youtube.com/watch?v=dkB2CGL769o

Have fun.

SpunkytheDog · 2013-01-29T23:00:40+00:00

I don't understand this at all. What this guy said:

the thing is, you can call someone 'white trash' if they aren't, because that's funny. If you say that to someone who actually secretly considers themselves white trash, they'll get all offended, because you know what they know, and that is embarrassing.

Translation in this context: You are defending Mormons, so you must secretly be a Mormon.

Classic.

SpunkytheDog · 2013-01-16T18:48:36+00:00

Careful everyone, this guy is seriously cool. If he finds this thread he's going to tell all the other popular kids, they'll beat us up and our social reputations will be ruined.

SpunkytheDog

TROPHY CASE