A 34-year-old ex-soldier with a history of post-traumatic stress disorder returns for review. He has had a course of eye movement desensitization and reprocessing therapy which was not helpful and is reluctant to try cognitive behavioural therapy.
Of the options listed, which medication may be useful in such patients?
Correct Answer C:
Post-traumatic stress disorder:
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.
Features:
from other people:
Management:
Which of the following types of tricyclic antidepressant is considered the safest in overdosage?
Correct Answer D: Lofepramine - the safest TCA in overdosage.
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 46-year-old man is seen by an occupation health doctor due to long-term sickness leave. He states chronic lower back pain prevents him from working but examination findings are inconsistent and the doctor suspects a non-organic cause of his symptoms.
This is an example of a:
Unexplained symptoms There are a wide variety of psychiatric terms for patients who have symptoms for which no organic cause can be found:
Somatization disorder:
Hypochondrial disorder:
Conversion disorder:
Dissociative disorder:
Munchausen's syndrome:
Malingering:
You are considering prescribing a selective serotonin reuptake inhibitor for a patient with depression.
Which class of drug is most likely to interact with a selective serotonin reuptake inhibitor?
Correct Answer E:
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 symptoms:
Which class of drug have the Medicines and Healthcare products Regulatory Agency warned may be associated with an increased risk of venous thromboembolism in elderly patients?
Correct Answer E: Antipsychotics in the elderly - increased risk of stroke and VTE.
Antipsychotics:
Antipsychotics act as dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways. Conventional antipsychotics are associated with problematic extrapyramidal side-effects which has led to the development of atypical antipsychotics such as clozapine.
Extrapyramidal side-effects:
The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:
Other side-effects:
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