Paper I
2016 October (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Read the case history and answer the following questions. A 25 years old man had a gradual onset of delusions and auditory hallucinations. He was taken to a psychiatrist who started him on tab. haloperidol 2mg twice daily. A few weeks later although he improved clinically he developed stiffness and rigidity of upper and lower limbs.

  • (a) Comment on the response of the patient to haloperidol. 2 mark(s)
  • (b) Outline the further line of management. 2 mark(s)
  • (c) Name two atypical antipsychotics. 2 mark(s)
Q26 marksEssays

Answer

(a) Comment on response to haloperidol

  • The patient’s psychotic symptoms (delusions, hallucinations) improved with haloperidol, confirming its antipsychotic efficacy (via D2 receptor blockade)
  • However, he has developed drug-induced (pseudo)parkinsonism, an extrapyramidal side effect resulting from D2 receptor blockade in the nigrostriatal pathway — haloperidol is a high-potency typical antipsychotic with a high propensity for extrapyramidal symptoms

(b) Further management

  • Reduce the dose of haloperidol if clinically feasible, or switch to an atypical antipsychotic with a lower extrapyramidal side-effect profile
  • Add an anticholinergic drug (e.g., Trihexyphenidyl) to counteract the parkinsonian symptoms
  • Continue monitoring for other extrapyramidal effects (akathisia, tardive dyskinesia with long-term use) and reassess psychiatric symptom control

(c) Two atypical antipsychotics

  • Olanzapine
  • Risperidone

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