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What is a GPCR, how is it a second messenger, and how does it mediate gene expression?
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It's been a while since 1st year med school, but....
A GPCR (G-Protein-Coupled-Receptor) is a transmembrane protein that has ligands on the inside of the cell. Ligands alter gene expression by binding GPCRs - usually a hormone or peptide such as TSH, norepi, or ACTH. Binding of a ligand to a receptor activates a G-protein which in turn initiates the production of a second messenger (usually cAMP). There are then a series of intracellular events, which activate transcription factor CREB (cAMP Response Element Binding Protein). The CREB eventually turns on gene transcription. DNA becomes the template for RNA, etc, etc.
Why do you ask?
A GPCR (G-Protein-Coupled-Receptor) is a transmembrane protein that has ligands on the inside of the cell. Ligands alter gene expression by binding GPCRs - usually a hormone or peptide such as TSH, norepi, or ACTH. Binding of a ligand to a receptor activates a G-protein which in turn initiates the production of a second messenger (usually cAMP). There are then a series of intracellular events, which activate transcription factor CREB (cAMP Response Element Binding Protein). The CREB eventually turns on gene transcription. DNA becomes the template for RNA, etc, etc.
Why do you ask?
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Ya that is what I learned in biochem/neuro chem as well. Perhaps I should have phrased my question differently. There is alot of buzz in the journals about G-protein receptors etc.., and I was hoping to get some dialogue, on a more clinical/applied level on what people are thinking is going on when say an SSRI is introduced etc...
s 🙂
s 🙂
He asked because his Master's degree program in psychopharmacology for psychologists did not teach him the cell biology needed to understand the basics of GPCRs in psychopharmacology. Pathways involving GPCRs are implicated in the actions of hundreds of drugs, including antidepressants (e.g., fluoxetine, nortryptiline) and neuroleptics (e.g., clozapine). The survey course on psychopharmacology that he attended every other weekend must have forgotten to review them.Anasazi23 said:
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LOL... No I just wanted to see if anyone knew...anyone who did not quote a first year med school text they have not read yet. Answer me when you are accepted to med school or have some training in anything..
psisci said:
Well you should go ask your "prescribing psychologist" colleagues, who unlike the people in a psychiatry forum, don't have any training in cell bio.
By the way, I'm an MS1 at NYCOM, and have read and been tested on GPCRs and more advanced topics as an undergraduate and medical student. I opted not to be a wanna-be psychiatrist like you.
Where do you work? I'll come by on externship and pimp you on GPCRs...
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You are funny.... The only problem with coming by the hospital I work on externship and trying to pimp me (whatever that means) is that I would the attending on staff, and you the student so you would lose anyhow....that's life as you will learn in school.
For the rest of you, I am still interested in some discussion about GPCR's as I find the subject very interesting. I actually have a pretty good grasp on what is known, as well as general cell biology both from my training and the fact that my wife has a PhD in biochemistry.... 😎
For the rest of you, I am still interested in some discussion about GPCR's as I find the subject very interesting. I actually have a pretty good grasp on what is known, as well as general cell biology both from my training and the fact that my wife has a PhD in biochemistry.... 😎
psisci said:
I was trying to bite my tongue on this but....
The fact that you don't know, or more importantly, have not experienced a pimp session is disappointing and unfortunate (look for threads on the subject). While I have detested them myself, they do serve one important purpose - one that I think these flailing psychologists trying to prescribe should learn. They impart a sense of humility...and has been the time un-tested yet successful means of imploring the concept of getting an understanding and realization that you don't know shi** about a given subject, regardless of how many textbooks you've read or how smart you think you are. They keep you honest, humble, and scared. All of which cause you to learn more. It forces the understanding that there are always physicians that will know more than you about any subject....and you must always remember that.
I think that is part of why folks are so disturbed about psychologists prescribing. The graduated medical student has demonstrated, and will in residency for years, that they have survived the academic and physical gauntlet that is clinical medicine training...something psychologists have not done, no matter which way you cut it. The oft-used term "shortcut" about these prescribing programs are really just that...a way for psychologists to prescribe without going through any of the character development or comprehensive understanding of every single organ system and other critical details relating to patients that a physician undergoes. You can't appreciate it until you've gone through it. It's a fraternity of sorts, and one that imparts a sense of mutual respect despite disagreements among physicians.
Calling yourself an attending in the above post, for example, will only cause increased eye-rolling by medical attendings, residents, and med students due to the explanation that I've provided. This began to take place when psychologists started calling their internships "residency." Real residents found this insulting, and feel that this minimizes the uncomparable workload and responsibility taken on by medical residents - very much including psychiatry residents.
While it's great that you find that you call more psychiatry consults because of knowledge you've garnered is great, but I fear that you will be in the minority. By listening to psychologists in their newsletters, posters, and in speech transcripts, it seems to any psychologically minded person that these folks have severe ego needs that are not filled in psychology, and that rxp is the easiest way to bypass that. They'll see, though, that something as mundane as carrying a prescription pad will not fill this need. Despite what psychologists think, this is only a small fraction of what makes a physician just that. Every time I take out my prescription pad I get a little nervous..."what if I missed something? What if there's a reaction with their HIV meds?" etc, etc, etc.) and that's with eons more training in clinical medicine than what psychologists get.
I simply cannot imagine trying to get through a day on the floors without my medical knowledge. I would feel completely inadequate if I didn't have it. Knowing that I've assisted and in some cases, performed cholecystectomies, delivered babies, helped perform reconstructive surgeries, watch a converting sine wave, pronounced death, and spent hundreds of hours on clinical medicine floors, in clinics, in ERs in OR suites, allows me to deal with the plethora of medical issues that patients will forever ask you about, and are often going through in some form themselves. The constant attempt to try to skirt medical issues you don't understand or avoid terms you've never heard, or talk intelligently to patients about their rare disease on the fly without having looked it up, or speaking about non-psychiatric medications to patients or their family members who have shown up unexpectedly would be mental torture, and humiliating to me.
The studies that psychologists are hoping will clear them as competent prescribers that are sure to come down the pipeline in a few years will not impress physicians...for they know that the vast majority of good psychiatry cannot be measured by rating scales and subjective (or objective) reports of adverse effects - it is only through a comprehensive understanding of the patient as a complete biological and psychological entity. Patients treated by prescribing psychologists will be hurt - that isn't the debate. The simple face validity of the scenario is self-evident. But it may not necessarily be through whether or not a patient vomits after a psychologists gives some venlafaxine and then comparing that to the physician-venlafaxine group. It is through the unmeasurable physician's clinical eye that will have patients improving their overall health. By lowering lipid panels that may make a person live a year longer, or by delicately adjusting the balance of medications in a radio-ablated thyroid patient with a confusing clinical picture. Or most importantly, just taking a look at the gestalt of a patient and saying, "There's something not quite right with the way you look." People talk about "full scope." Not knowing what the hell you're doing with these patients and hoping you've even called the correct discipline for a consult is not full scope. It's fulfilling an ego and identity need.
As the above poster mentioned, psychiatry will not be hurt by this. There will always be sick patients, and physicins will always be looked upon as the preeminent clinician for these patients, and that only makes sense. There are increased death rates when nurse anesthetists administer anesthesia. (See the most recent literature.) That is no surprise. Our treatments are less immediately kinetic, compared to administering paralytic agents, but are robust nonetheless. If I've learned anything through medical school and the beginnings of residency, it's that I still have a tremendous amount to learn about medical patients, and have a lifetime to try to gain the knowledge I need to successfully and and comprehensively treat them.
Sad sad people. The man asked for an intellectual dialogue but got you two instead 🙁
Nice, thoughtful post, Anasazi. I can't believe that psychologists are already acquiring these snotty, superior attitudes -- about medications and pharmacology, no less! I never thought of it in exactly that way before, but your points on the whole, grueling medical school experience as an asset were very insightful and (I believe) accurate. I'm sure that can be duplicated in a weekend training course. 🙂
PsyDRxPnow,
Please inform us ignorant medical students and residents with your "intellectual dialogue" about GPCRs and their role in psychopharmacology.
psicsi,
Looks like Anasazi beat me to the pimping!
Please inform us ignorant medical students and residents with your "intellectual dialogue" about GPCRs and their role in psychopharmacology.
psicsi,
Looks like Anasazi beat me to the pimping!
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Publichealth...I love you man!!! You know you are the kind of guy I would probably get along with..arrogance and all. I guess you could not teach me anything about GPCRs, but I think you need to know that the ligand always binds on the outside of the cell. Are you a football fan....perhaps you could tell me how lame the 49ers are??? Relax man we are all in this together...
cheers 🙂
cheers 🙂
PublicHealth said:PsyDRxPnow,
Please inform us ignorant medical students and residents with your "intellectual dialogue" about GPCRs and their role in psychopharmacology.
psicsi,
Looks like Anasazi beat me to the pimping!
Public Health, if I cared enough to educate you, I would have looked it up but I will not due to lack of interest and time constrained.
PsyDRxPnow said:
That's a great strategy! If I ever needed psychopharmacologic care, I would readily put my life in your hands. Having a "prescribing psychologist" look up the basics of cell biology prior to educating or treating patients is a surefire way to demonstrate your proficiency in clinical medicine and psychiatry.
Keep in mind that while you're enjoying your winter break from your overpriced PsyD program, most medical students (yours truly included) will have their faces buried in basic science textbooks and review books so that they understand the full range of medicine and so that they have the training necessary to correct the errors in patient care that "prescribing psychologists" will inevitably make.
Have fun paying off your $100K loan in an uncertain job market.
P.S., It's time constraint, not constrained.
psisci said:
Philadelphia all the way!
PublicHealth said:
Hey, do what you love!!! 😍
