Neurophysiological effects of hallucinogens may include all of the following, except:
Correct Answer A:
Hallucinogens can produce physiological effects including elevated heart rate, increased blood pressure, and dilated pupils. These drugs are often unpredictable and a user may experience different effects compared to other users or past usage. Users often experience changes in perception, thought, and mood.
A 32 year old man with schizophrenia is brought to the hospital by his sister because he has become incoherent and locks himself in his room for days at a time. His family is concerned because he has tried many antipsychotic agents and none of them seem to have worked. Physical examination is normal. He is placed on clozapine and scheduled for a visit to the clinic in 1 week. One week later, he arrives at the clinic for his appointment.
Which of the following is the most appropriate test at this time?
Clozapine is an atypical antipsychotic that may produce agranulocytosis, requiring weekly monitoring of the CBC. Clozapine blocks both dopamine and serotonin receptors and causes only minimal extrapyramidal side effects. It is effective in treating the negative symptoms of schizophrenia and is often used in treatment-resistant cases. In addition to causing agranulocytosis (1% incidence), clozapine therapy has a 5-10% incidence of seizures, but weekly EEGs are not performed. It does not increase the prolactin level.
A 22 year old male is admitted to a psychiatric unit for stabilization of an acute episode of psychosis. He has been started on an antidepressant, an antipsychotic, and has required additional medications on several occasions for agitation. On the fifth day of his hospitalization, he develops a sustained muscular contraction involving his left neck muscles, with associated pain and distress.
Which of the following medications is most likely responsible for this acute reaction?
Correct Answer B:
This patient is experiencing neuroleptic-induced acute dystonia. About 10% of patients experience dystonia as an adverse effect of antipsychotics, usually within the first few days of treatment. Dystonia can involve the neck (torticollis), the jaw, the tongue, the eyes, other specific muscle groups, and the entire body. Dystonias are most common with high potency conventional antipsychotics, such as haloperidol. Pseudoparkinsonism and akathisia are other forms of acute extrapyramidal side effects.
A 50 year old woman with a past history of recurrent major depressive disorder is currently on a maintenance dose of an antidepressant. She has been well for the past 2 years. She is complaining to her psychiatrist about her decreased ability to reach orgasm.
Which of the following medications has most likely caused her anorgasmia?
Correct Answer E: Paroxetine, along with other selective serotonin reuptake inhibitors, can cause decreased libido and difficulties reaching orgasm. In studies, the incidence of these side effects was 1% to 2% in patients on paroxetine, compared with those on placebo.
A 26-year-old man with schizophrenia comes to the emergency department with a 2 hour history of involuntary contractions of the muscles in his neck. He states that he was watching television and "all of a sudden I turned my head and my neck locked". He began taking a high-potency antipsychotic agent 3 days earlier. Examination shows no abnormalities except torticollis.
Which of the following is the most appropriate pharmacotherapy?
This patient has acute dystonia. Dystonia is characterized by involuntary muscle spasms, which in this patient, are due to a high potency antipsychotic agent. Dystonia is most common in young men, and often begins within days of starting the drug therapy. It usually involves the muscles of the head and neck, leading to torticollis and blepharospasm. It can produce a life-threatening laryngospasm requiring intubation. The treatment of acute dystonia is with anticholinergic medications, such as benztropine or diphenhydramine.
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