Alzheimer’s Delirium and Dementia Q 25
Propanolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety.
B. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior.
C. Delusions for clients suffering from schizophrenia.
D. The manic phase of bipolar illness as a mood stabilizer.
Correct Answer: A. Antipsychotic-induced akathisia and anxiety
Propranolol is a potent beta-adrenergic blocker and produces a sedating effect, therefore it is used to treat antipsychotic-induced akathisia and anxiety. Off-label use of propranolol includes the use in performance anxiety, which is a subset of a social phobia presenting with tachycardia, sweating, and flushing that occurs secondary to increased activation of the sympathetic nervous system.
Option B: OCD is most commonly treated with SSRIs, and at much higher doses than used to treat anxiety or depression. FDA-approved SSRIs include fluoxetine, fluvoxamine, paroxetine, and sertraline. The following are appropriate drugs and doses typically used to treat OCD: fluoxetine 80 mg, escitalopram 40 mg, 300 mg fluvoxamine, and 100 mg paroxetine.
Option C: For the initial treatment of acute psychosis, it is recommended to commence an oral second-generation antipsychotics (SGA) such as aripiprazole, olanzapine, risperidone, quetiapine, asenapine, lurasidone, sertindole, ziprasidone, aripiprazole, molindone, iloperidone, etc. Sometimes, if clinically needed, alongside a benzodiazepine such as diazepam, clonazepam, or lorazepam to control behavioral disturbances and non-acute anxiety. First-generation antipsychotic (FGA) like trifluoperazine, Fluphenazine, haloperidol, pimozide, sulpiride, flupentixol, chlorpromazine, etc. are not commonly used as the first line but can be used.
Option D: A large meta-analysis of medications used in acute mania showed that atypical antipsychotics were more effective than mood stabilizers for this purpose but not necessarily for maintenance of bipolar disorder. The most effective medications are risperidone, olanzapine, and haloperidol. Lithium, quetiapine, and aripiprazole were comparatively effective. Valproic acid, carbamazepine, and ziprasidone were more efficacious than placebo but less so than their previously mentioned competitors.