AIIMS Raipur - 2017 (Shift-3)
Mental Health Nursing
Easy
Which among the following drug is suitable in case of Obsessive Compulsive Disorder (OCD)?
Appeared in: AIIMS Raipur - 2017 (Shift-3)
Explanation
- Clomipramine is a tricyclic antidepressant (TCA) that uniquely among TCAs has a very strong inhibitory effect on serotonin reuptake.
- The obsessions and compulsions in OCD are strongly linked to dysregulation in the brain's serotonin system.
- Clomipramine's potent serotonergic action directly targets this underlying neurobiology, making it highly effective.
- It is the only tricyclic antidepressant that has received FDA approval specifically for the treatment of Obsessive-Compulsive Disorder.
Why Other Options Were Wrong
- Option A: Amitriptyline is a TCA, but its primary use is for depression, chronic pain syndromes, and migraine prophylaxis. Its serotonergic effects are not as potent as Clomipramine's, making it less effective for OCD.
- Option C: Desipramine is a TCA that primarily acts on norepinephrine reuptake, with weak effects on serotonin. Studies have directly compared it to Clomipramine and found it to be significantly less effective for treating OCD symptoms.
- Option D: Mirtazapine is an atypical antidepressant that works through a different mechanism (alpha-2 antagonist). It is not a standard or recommended treatment for OCD.
Related Visual
Clinical Relevance
- Nursing practice connection: Knowing Pharmacological Management of Obsessive-Compulsive Disorder (OCD) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Nurses must diligently monitor patients on Clomipramine for anticholinergic side effects (dry mouth, constipation, blurred vision, urinary retention) and cardiac effects (tachycardia, orthostatic hypotension, ECG changes).
- Patient education is critical. Inform the patient that the therapeutic effects for OCD may take 10-12 weeks to become fully apparent to promote medication adherence.
- Clomipramine carries a risk of seizures and delirium, especially at higher plasma concentrations (greater than 300 ng/mL). Monitoring for mental status changes is a key safety intervention.
How to Approach the Question
- First, identify the core of the question: selecting the most appropriate medication for a specific psychiatric diagnosis, which is Obsessive-Compulsive Disorder (OCD).
- Recall the primary neurotransmitter system implicated in OCD, which is the serotonin system. Therefore, drugs with strong serotonergic action are the most effective treatments.
- Analyze the options provided. All are antidepressants, but they belong to different classes or have different primary mechanisms of action.
- Evaluate each option's suitability for OCD. Clomipramine is a tricyclic antidepressant (TCA) well-known for its potent serotonin reuptake inhibition and its specific FDA approval for OCD.
- Contrast this with the other options. Amitriptyline and Desipramine are also TCAs, but they are less serotonergic (especially Desipramine, which is more noradrenergic). Mirtazapine is an atypical antidepressant with a different mechanism.
- Conclude that Clomipramine is the most specific and effective choice for OCD among the given drugs.
Concept Tested & Keywords
- Concept Tested: Pharmacological Management of Obsessive-Compulsive Disorder (OCD)
- Stem keywords: drug, Obsessive Compulsive Disorder, OCD
- Lead-in keywords: suitable
- Negative lead-in flag: false
Question ID
QKSPkjraCJtKgINkKM2JFw
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 10249-10251, 12496-12498, 12306-12308
Practise the full AIIMS Raipur - 2017 (Shift-3)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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