Question

Case #1.

A 48-year-old woman with a past history of recurrent major depression is admitted to a locked ward during a relapse. On the day of admission, she is placed on nortriptyline 50 mg and risperidone 2 mg at bedtime. Ten days later, the patient reports with great concern that her nipples are leaking.

1. Which class of medications is known to cause this condition?

1. Benzodiazepines
2. Neuroleptics
3. Serotonin reuptake inhibitors
4. Beta blockers

2. What mechanism is responsible for this site effect?

Case #2.

An 80-year-old man undergoes an evaluation for dementia versus depression. His caregiver describes a history of gradually worsening depressed mood and confusion with poor appetite, self-care and irritability.

He is alert and oriented to person and place, but not to time. His concentration is impaired, and he displays poor short-term memory despite adequate recall. His effort is poor overall, and he often responds to questions stating, “I don’t know”.

1. Which of the following features is more consistent with a depressive illness than with dementia?

1. Poor concentration
2. Poor effort during the interview
3. Poor self-care
4. Poor short-term memory

2. Which of the following statements regarding the psychopharmacologic treatment of geriatric patients is most accurate?

1. Fewer side effects are reported
2. Higher doses are used.
3. Lower blood levels are needed.
4. More drug-drug interactions are seen.

3. Which of the following is the best indication for using ECT in an elderly patient with major depression?

1. Multiple medical problems
2. Psychotic symptoms
3. Recurrent episodes
4. Suicidal ideation without a plan

Answer 1

Case 1

The nipple leaking is possible only when the hormone prolactin is increased .Drugs like antihypertensive, antidepressants, antipsychotics , sedatives can cause nipple discharge. Benzodiazepine is an antianxiety drug. Neuroleptic acts on the nervous system and can cause hyperprolactnemia .Searatonin reuptake inhibitor increases prolactin level and can cause nipple discharge .Beta blockers dies not cause galactorrhea

Ans:Neuroleptic

These drugs acts on the dopamine receptors which are responsible to control prolactin level.when this receptors are affected the dopamine receptors enhances to produce more prolactin and results in nipple discharge

Case 2

1.Depressive illness is a state where patient not only exhibits emotional illness but also physical illness .A typical sign which can make one diagnose is either poor self care by avoiding to take care of self.Short term memory like poor concentration ,short term memory are sign of dementia.

Ans:Poor self care

2.In geriatric patients they experience adverse reactions and regret are high chances of drug drug interactions. High doses are not recommended for geriatric cases because of decrease in renal functions.Blood levels are should be within normal ranges.

Ans:more drug-drug interactions are seen

3.ECT are indicated for bipolar disorder, schizophrenia, major depressive disorder ,mania,catatonia ,suicidal thoughts

Ans:Suicidal ideation without a plan