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Difficulty: HardPsychopharmacology and Psychological Therapies

Match each patient's clinical presentation of a psychotropic adverse effect with the medication most likely responsible.

  • A 24-year-old woman develops a painful, blistering rash with oral mucosal ulcerations two weeks after initiating a new medication for bipolar depression.Lamotrigine
  • A 42-year-old man exhibits sudden, sustained neck muscle contraction and upward eye deviation hours after receiving an intramuscular injection for severe agitation.Haloperidol
  • A 55-year-old man with bipolar I disorder presents with excessive thirst and frequent urination; laboratory tests show a low urine osmolality that remains unchanged after desmopressin administration.Lithium
  • A 35-year-old woman develops a resting tremor, slowed movements, and cogwheel rigidity several weeks after starting a medication for a recent psychotic episode.Risperidone
  • A 29-year-old woman experiences severe dizziness, flu-like symptoms, and sensory disturbances described as 'brain zaps' 48 hours after abruptly discontinuing her daily medication for generalized anxiety disorder.Paroxetine

Answer

Lamotrigine causes Stevens-Johnson syndrome; Haloperidol causes acute dystonia; Lithium causes nephrogenic diabetes insipidus; Risperidone causes drug-induced parkinsonism; Paroxetine causes antidepressant discontinuation syndrome.
Each patient presentation highlights a classic and severe side effect unique to or highly characteristic of a specific psychotropic medication. Recognizing these toxidromes is critical for safe medication management and rapid intervention.

Step-by-Step Solution

1
Identify the underlying diagnosis for the specific adverse effect described in each patient presentation.
The presentations describe Stevens-Johnson syndrome (rash with mucosal involvement), acute dystonia (torticollis/oculogyric crisis), nephrogenic diabetes insipidus (polyuria unresponsive to desmopressin), drug-induced parkinsonism (tremor/rigidity), and discontinuation syndrome (flu-like symptoms and 'brain zaps').
Accurately recognizing the toxidrome or side effect is the necessary first step to matching it with the offending medication.
2
Correlate each identified adverse effect with the psychotropic medication known to cause it based on its pharmacologic profile.
Stevens-Johnson syndrome is matched with Lamotrigine. Acute dystonia is matched with Haloperidol. Nephrogenic diabetes insipidus is matched with Lithium. Drug-induced parkinsonism is matched with Risperidone. Discontinuation syndrome is matched with Paroxetine.
Linking the clinical presentation to the offending agent demonstrates mastery of psychopharmacologic side effect profiles.

Key Concept

Psychotropic medication adverse effects and toxicity syndromes
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Topics

Psychopharmacology and Psychological Therapies

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