Course Description
Thorazine was discovered in the 1950s with the understanding that dopamine antagonism was needed for antipsychotic action. This medication and the many first- and second-generation antipsychotics that followed are effective in reducing psychotic symptoms but most approved to date have relatively high binding affinity (60-80%) to the dopamine 2 (D2) receptor thought to be needed for their efficacy.
Antagonizing these post synaptic dopamine receptors often produces distressing adverse events including extrapyramidal side effects (EPS), akathisia and hyperprolactinemia. Many newer second-generation agents have reduced these neurologic side effects by adding serotonin type 2A (5-HT2A)–receptor antagonism to D2-receptor antagonism. While lower rates of these D2 related adverse effects are seen, these adverse effects remain variable among agents. These adverse effects have contributed to early discontinuation, nonadherence, rehospitalizations and medical comorbidities.
Recently approved and emerging antipsychotic medications that have low post synaptic D2 binding or without direct dopamine modulation have lower side effect burdens than older medications. This may introduce a new generation to treatments for schizophrenia where patients may never experience some of the severe adverse events. There is a great need to provide better efficacy and side effect burdens for our patients requiring that we understand these new mechanisms and consider these "third-generation" treatments early in the course of illness in order to prevent the adverse consequences.
During this activity participants will review the pharmacologic mechanisms and adverse effects related to receptor binding of antipsychotics, understand the role of D2 related adverse effects such as extrapyramidal side effects, akathisia, and hyperprolactinemia on patient outcomes, and learn the weight related side effect liabilities of existing agents. Lastly, participants will be able to discuss the novel pharmacological properties of newer, emerging and pipeline “third-generation” antipsychotics and the benefits of these medications in avoiding or minimizing adverse effects.
Learning Objectives
- Review the pharmacologic history, mechanisms, and adverse effects related to receptor binding of antipsychotics and the evolving history of the dopamine hypothesis for psychosis treatment.
- Understand the role of D2 related adverse effects such as extrapyramidal side effects, akathisia and hyperprolactinemia on patient nonadherence, discontinuation, and outcomes. Consider weight related side effect liabilities of these agents.
- Discuss the novel pharmacological properties of newer, emerging and pipeline "third-generation" antipsychotics and the benefits of these medications in avoiding or minimizing adverse effects and novel mechanisms beyond post-synaptic D2 blockade.
Target Audience
If you are a pharmacist, nurse practitioner, or other health care professional involved in the comprehensive medication management of individuals living with mental health and/or substance use disorders, we invite you to participate in this online course.
Faculty
View biographical information
Christoph U. Correll, MD
Professor of Psychiatry and Molecular Medicine
The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
Professor and Chair, Child and Adolescent Psychiatry
Charité – Universitätsmedizin, Berlin, Germany
Full Bio
Christoph Correll is Professor of Psychiatry at The Zucker School of Medicine at Hofstra/Northwell, New York, USA, and also Professor and Chair of the Department of Child and Adolescent Psychiatry, Charité University Medicine, Berlin, Germany. He completed his medical studies at the Free University Berlin, Germany, and Dundee University Medical School, Scotland. He is board certified in general psychiatry and child and adolescent psychiatry, having completed both residencies at The Zucker Hillside Hospital in New York. Since 1997, he has been working and conducting research in New York, USA, and since 2017 he is also working in Germany again.
Prof. Correll’s research and clinical work focus on the identification, characterization and treatment of youth and adults with severe mental illness, including psychotic and mood disorders. He further focuses on psychopharmacology, epidemiology, clinical trials, comparative effectiveness, meta-analyses, and the interface between physical health and mental health.
He has authored over 650 journal articles, served on several expert consensus panels, and received over 40 research awards for his work.
Since 2014, the year of inception of this metric, he has been listed every year by Clarivate/Web of Science as one of the “most influential scientific minds” and “top 1% cited scientists in the area of psychiatry.”
Additionally, he has been holding numerous Expertscape rankings, such as 15 topics ranked as “Expert” (among the top 1% cited scientists), and 24 topics ranked as “World Expert” (among the top 0.1% cited scientists). For example, April 2021, he was ranked number one among world experts for topics such as Central nervous system agents; Central nervous system depressants; Schizophrenia; Schizophrenia Spectrum and Other Psychotic Disorders; Psychotropic drugs; Antipsychotics; Delayed-action preparations; Tranquilizing agents; and Weight gain.
Austin R. Campbell, PharmD, BCPP
Clinical Pharmacy Specialist – Psychiatry
University of Missouri Health Care, Columbia, MO
Full Bio
Dr. Austin Campbell Pharm.D., BCPP, is a clinical pharmacy specialist in psychiatry with University of Missouri Health Care in Columbia, Missouri. Additionally, he is an adjunct clinical assistant professor with the University of Missouri – Kansas City (UMKC) School of Pharmacy and an adjunct assistant professor with the University of Missouri Medical School. He currently practices as an acute inpatient psychiatric pharmacist for children, adolescents, and adults at the Missouri Psychiatric Center in Columbia, MO.
Dr. Campbell graduated from the UMKC School of Pharmacy in 2008. He went on to completed a first year postgraduate residency at the Kansas City VA Medical Center and a second year specialty residency in psychiatry at the Center for Behavioral Medicine in Kansas City before obtaining his board certification in psychiatric pharmacy (BCPP). As an avid educator, Dr. Campbell has received multiple awards for his service to the community and commitment to training students, residents, and fellows. He is recognized throughout the state of Missouri for his outreach and education efforts with the National Alliance on Mental Illness (NAMI), the Department of Mental Health, Missouri Telehealth Network, and the Missouri Children’s Health Integration Learning and Development (MO CHILD) Center for Excellence. Since 2016 he has been an active member of Project ECHO (Extension for Community Healthcare Outcomes) and has helped in the creation and launch of two separate ECHOs for child and adolescent psychiatry as well as autism crisis care. Dr. Campbell is an active member of the College of Psychiatric and Neurologic Pharmacists (CPNP) serving as a member of several committees and editorial boards and is the current programing chair for the 2022 Annual Meeting.
Faculty Disclosures
Grant/Research Support: Christoph U. Correll: Janssen, Takeda
Consultant: Christoph U. Correll: AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Axsome, Damitsa, Gedeon Richter, Hikma, IntraCellular Therapies, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Medscape, Merck, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, Teva, and Viatris
Austin Campbell: Otsuka Pharmaceutical Co. Ltd. (served on PsychU National Forum panel, October 2020)
Speakers Bureau/Educational Services: Austin Campbell: Sunovion Pharmacueticals Inc.
Financial: Austin Campbell: UpToDate (author royalties)
Presentation will include discussion of off-label, experimental, and/or investigational use of drugs or devices: Christoph U. Correll: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: SEP856, Pimavanserin for schizophrenia, Xanomeline + Trospium for schizophrenia, TAK-831 for schizophrenia, deutetrabenazine and valbenazine for schizophrenia, lumateperone for bipolar depression
Course Requirements
To receive ACPE credit for this session, you must:
- Register for this course.
- Complete the pre-test (if applicable) before starting the activity.
- Review the full content of the activity and reflect upon its teachings.
- Complete the post-test at the end of the activity no later than the closing activity date.
- Complete the evaluation at the end of the activity.
- If necessary, complete the post-test retest no later than the closing activity date.
- Receive a passing grade (70%).
- Provide the necessary details in your profile to ensure correct reporting by AAPP to CPE Monitor.
Continuing Education Credit and Disclosures
Webinar Date: 08/24/2021 1:00PM central
Activity Dates: 08/24/2021 - 08/24/2024
ACPE Contact Hours: 1
ACPE Number: 0284-0000-21-060-H01-P (Knowledge)
Nursing Credit Reminder: Note that ACPE credit is accepted for ANCC Certification Renewal and AANPCB advanced practice provider content. For specific questions related to your organization's acceptance of ACPE continuing education units, please contact your organization directly.
The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
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View disclaimer and disclosure of off-label use
Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information). The opinions expressed in the educational activity do not necessarily represent the views of AAPP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Presentation-Specific Disclosure: Christoph U. Correll: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: SEP856, Pimavanserin for schizophrenia, Xanomeline + Trospium for schizophrenia, TAK-831 for schizophrenia, deutetrabenazine and valbenazine for schizophrenia, lumateperone for bipolar depression
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It is the policy of AAPP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.
Fair balance is achieved through ongoing and thorough review of all materials produced by faculty, and all educational and advertising materials produced by supporting organizations, prior to educational offerings. Approval of credit for this continuing education activity does not imply endorsement by AAPP for any product or manufacturer identified.