Schizophrenia Q 28
Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety.
B. The manic phase of bipolar illness as a mood stabilizer.
C. Delusions for clients suffering from schizophrenia.
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior.
Correct Answer: A. Antipsychotic-induced akathisia and anxiety
Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it’s 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: Lithium (Lithobid) is used to stabilize clients with bipolar illness. Lithium was the first mood stabilizer and is still the first-line treatment option, but is underutilized because it is an older drug. Lithium is a commonly prescribed drug for a manic episode in bipolar disorder as well as maintenance therapy of bipolar disorder in a patient with a history of a manic episode. The primary target symptoms of lithium are mania and unstable mood.
Option C: Antipsychotics are used to treat delusions. The first-generation antipsychotics work by inhibiting dopaminergic neurotransmission. Their effectiveness is best when they block about 72% of the D2 dopamine receptors in the brain. They also have noradrenergic, cholinergic, and histaminergic blocking action. Second-generation antipsychotics work by blocking D2 dopamine receptors as well as serotonin receptor antagonist action. The 5-HT2A subtype of serotonin receptor is most commonly involved.
Option D: Some antidepressants have been effective in treating OCD. 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. Two primary neurotransmitters are thought to contribute to OCD: serotonin and glutamate. The serotonin hypothesis arose after OCD symptoms abated with the use of serotonergic antidepressants.