A 34-year-old man confides in you that he experienced childhood sexual abuse.
Which one of the following features is not a characteristic feature of post-traumatic stress disorder?
Correct Answer D: Post-traumatic stress disorder (PTSD) can develop in people of any age following a traumatic event, for example a major disaster or childhood sexual abuse. It encompasses what became known as 'shell shock' following the first world war. One of the DSM-IV diagnostic criteria is that symptoms have been present for more than one month.
Post-traumatic stress disorder
Features:
Management:
A 25-year-old man with a history of schizophrenia is prescribed olanzapine.
Which one of the following adverse effects is he most likely to experience?
Correct Answer D: Weight gain is an extremely common adverse effect of atypical antipsychotics such as olanzapine.
Atypical antipsychotics: Atypical antipsychotics should now be used first-line in patients with schizophrenia, according to 2005 NICE guidelines. The main advantage of the atypical agents is a significant reduction in extrapyramidal side-effects.
Adverse effects of atypical antipsychotics:
The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:
Examples of atypical antipsychotics:
Clozapine, one of the first atypical agents to be developed, carries a significant risk of agranulocytosis and full blood count monitoring is therefore essential during treatment. For this reason clozapine should only be used in patients resistant to other antipsychotic medication.
Adverse effects of clozapine:
A 39-year-old man comes for review. Six months ago he was started on paroxetine for depression. Around five days ago he stopped taking the medication as he felt that it was having no benefit. His only past medical history of note is asthma. For the past two days he has experienced increased anxiety, sweating, headache and the feeling of a needle like sensation in his head. During the consultation he is pacing around the room.
What is the most explanation for his symptoms?
Correct Answer C: Paroxetine has a higher incidence of discontinuation symptoms than other selective serotonin reuptake inhibitors.
Depression: selective serotonin reuptake inhibitors:
Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for the majority of patients with depression:
Adverse effects:
Interactions:
Following the initiation of antidepressant therapy patients should normally be reviewed by a doctor after 2 weeks. For patients under the age of 30 years or at increased risk of suicide they should be reviewed after 1 week. If a patient makes a good response to antidepressant therapy they should continue on treatment for at least 6 months after remission as this reduces the risk of relapse. When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.
Discontinuation Smptoms:
You are considering prescribing a tricyclic antidepressant for a patient who has not responded to two different types of selective serotonin reuptake inhibitors.
Which one of the following tricyclic antidepressants is most dangerous in overdose?
Correct Answer A: Dosulepin - avoid as dangerous in overdose.
Tricyclic antidepressants: Tricyclic antidepressants (TCAs) are used less commonly now for depression due to their side effects and toxicity in overdose. They are however used widely in the treatment of neuropathic pain, where smaller doses are typically required.
Common side-effects:
Choice of tricyclic:
*Trazodone is technically a 'tricyclic-related antidepressant'
A 23-year-old male presents to his GP two weeks after a road traffic accident concerned about increased anxiety levels, lethargy and headache. At the time he had a CT brain after banging his head on the steering wheel, which revealed no abnormality. Six months following this episode his symptoms have resolved.
What did his original symptoms likely represent?
Correct Answer E: In post-traumatic stress disorder the onset of symptoms is usually delayed and it tends to run a prolonged course.
Post-concussion syndrome: Post-concussion syndrome is seen after even minor head trauma Typical features include:
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