Question 41#

The most common cause for mortality in ECT (Electroconvulsive Therapy) is:

A. Fracture of the dorsal vertebrae

B. Mortality with ECT is about the same as that with general anaesthesia for any minor surgery. The American Psychiatric Association Task Force on ECT estimated that the ECT-related mortality rate is 1 in 10,000 patients or 1 in 80,000 treatments. ECT is considered a low-risk procedure, even in an elderly cardiac patient who, in the developed world, is fast becoming the modal candidate for ECT. It is noted that ECT is about 10 times safer than childbirth and, each year, approximately six times as many deaths in the USA are caused by lightning than by ECT. In those who die, the commonest cause is a cardiac event, usually an arrhythmia. 

Reference:

1. Abrams R. The mortality rate with ECT. Convulsive Therapy 1997; 13: 125–127.

Question 42#

When comparing unilateral and bilateral ECT (Electroconvulsive Therapy) which of the following is true?

A. Memory deficits are less common with bilateral than unilateral ECT

D. Overall, bilateral ECT has superior efficacy compared to unilateral, although bilateral is associated with more side-effects. Recent studies have shown that high-dose unilateral is better than low-dose bilateral in terms of side-effects and equivalent in terms of efficacy. When choosing right unilateral placement, a higher dose titration is preferred. If there is a need for urgent improvement, bilateral placement is recommended.

Reference:

1. Gelder MG et al., eds. Shorter Oxford Textbook of Psychiatry, 5th edn. Oxford University Press, 2006, p. 567.

Question 43#

Which of the following has the shortest plasma half-life?

A. Zolpidem

B. Z hypnotics are non-benzodiazepines which act at or close to the benzodiazepine receptor site in the GABAA complex. Its action is reversed by flumazenil. Zaleplon has the shortest half-life (1 hour) among the sedatives listed in the question. Temazepam (5–11 hours) and clomethiazole (4–6 hours) are also used as hypnotics. They are usually prescribed short term for the induction of sleep, usually for not more than 2 weeks.

Reference:

1. Gelder MG et al., eds. Shorter Oxford Textbook of Psychiatry, 5th edn. Oxford University Press, 2006, p. 529.

Question 44#

An elderly gentleman recently started on a hypnotic complains of sneezing and conjunctival irritation.

He was most probably started on which of the following drugs?

A. Temazepam

D. Clomethiazole is a hypnotic with anticonvulsant properties. It causes dependence and respiratory depression with alcohol. It is used in elderly people because of its relatively shorter half-life. Unwanted side-effects include sneezing, conjunctival irritation, and nausea.

Reference:

1. Gelder MG et al., eds. Shorter Oxford Textbook of Psychiatry, 5th edn. Oxford University Press, 2006, p. 530.

Question 45#

Which of the following is the most potent depot antipsychotic in terms of mg per mg?

A. Risperidone long acting

E. Pipothiazine is the most potent in terms of dose–response of the depot neuroleptics; 5 mg of pipothiazine is equivalent to: 100 mg of haloperidol, 25 mg of risperidone, 25 mg of fluphenazine, 40 mg of flupentixol, and 200 mg of zuclopenthixol.

Reference:

1. Gelder MG et al., eds. Shorter Oxford Textbook of Psychiatry, 5th edn. Oxford University Press, 2006, p. 533.