Personality and Mood Disorders Q 23
A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be:
A. fluvoxamine (Luvox)
B. benztropine (Cogentin)
C. amantadine (Symmetrel)
D. diphenhydramine (Benadryl)
Correct Answer: A. fluvoxamine (Luvox).
This drug blocks the uptake of serotonin. Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won’t go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
Option B: Benztropine belongs to the synthetic class of muscarinic receptor antagonists (anticholinergic drug). Thus, it has a structure similar to that of diphenhydramine and atropine. However, it is long-acting so that its administration can be with less frequency than diphenhydramine. It also induces less CNS stimulation effect compared to that of trihexyphenidyl, making it a preferable drug of choice for geriatric patients. Moreover, benztropine is FDA approved as adjunctive therapy of all forms of parkinsonism.
Option C: Amantadine is now used mostly for Parkinson’s disease. Clinical trials have shown that amantadine decreases symptoms of bradykinesia, rigidity, and tremor. There is a combined synergistic effect with added levodopa, which is converted to dopamine by striatal enzymes in the CNS. There can be a transient benefit to the drug, so short-term therapy for patients with the mild disease is best.
Option D: Diphenhydramine, which is available as an over-the-counter medication, is a first-generation antihistamine that is used in a variety of conditions to treat and prevent dystonias, insomnia, pruritus, urticaria, vertigo, and motion sickness. It also possesses local anesthetic properties for those patients who have allergies to other, more commonly used local anesthetics; however, this is an off-label use of the medication. An additional off-label use is for the treatment of oral mucositis.