Question 1
A) Electroconvulsive Therapy (ECT) in Mental Health Management [10 Marks]
Definition: Electroconvulsive Therapy (ECT) is a medical procedure used to treat certain
psychiatric conditions. It involves passing controlled electric currents through the brain to induce
brief seizures, which can lead to significant improvements in mental health symptoms,
particularly when other treatments have failed.
Indications:
● Severe major depressive disorder, especially with suicidal ideation or psychotic features.
● Treatment-resistant depression.
● Bipolar disorder with severe manic or depressive episodes.
● Catatonia.
● Schizophrenia, particularly with catatonic features or when rapid symptom control is
needed.CDC
Administration:
● ECT is typically administered 2–3 times per week.
● A typical course consists of 6–12 sessions, depending on the patient's response.
● The procedure is performed under general anesthesia with muscle relaxants to minimize
discomfort and prevent injury.
● Electrodes are placed on the scalp, and electrical stimulation is delivered to induce a
controlled seizure.Health
Side Effects/Risks:
● Short-term memory loss and confusion, which usually resolve within days to weeks.
● Headaches, muscle aches, and nausea post-procedure.
● In rare cases, long-term memory problems may occur.
● Risks associated with anesthesia, especially in patients with cardiovascular
issues.Cleveland Clinic
Precautions/Contraindications:
● Caution in patients with recent myocardial infarction, unstable cardiovascular conditions,
or increased intracranial pressure.
● A thorough medical evaluation is essential before initiating ECT to assess potential risks.
B) i. Drug Concordance [5 Marks]
Definition: Drug concordance refers to a collaborative approach between healthcare providers
and patients in making decisions about treatment regimens. Unlike compliance, which implies
passive following of medical advice, concordance emphasizes mutual agreement and respect for
the patient's preferences and values.
ii. Strategies to Improve Patient Concordance:
● Patient Education: Provide clear information about the condition and the benefits and
potential side effects of the medication.
● Simplify Regimens: Use once-daily dosing or fixed-dose combinations to reduce
complexity.
● Shared Decision-Making: Involve patients in choosing treatment options to enhance
ownership and commitment.
● Regular Follow-Up: Monitor progress and address concerns promptly.
● Use of Reminders: Implement tools like pillboxes, alarms, or mobile apps to aid
adherence.
iii. Factors Contributing to Poor Drug Concordance:
1. Complex Medication Regimens: Multiple daily doses can be confusing and
burdensome.
2. Side Effects: Unpleasant adverse effects may discourage continued use.
3. Lack of Insight: Patients with certain psychiatric conditions may not recognize their
illness or the need for treatment.
4. Cultural Beliefs: Traditional or religious beliefs may conflict with biomedical
treatments.
5. Poor Communication: Inadequate explanation from healthcare providers can lead to
misunderstandings about the importance of the medication.
C) Challenges with First-Generation Antipsychotics and Counseling Interventions [15
Marks]
Challenges:
● Extrapyramidal Symptoms (EPS): These include tremors, rigidity, bradykinesia, and
tardive dyskinesia, resulting from dopamine blockade in the nigrostriatal pathway.
● Sedation: Many first-generation antipsychotics have sedative properties, affecting daily
functioning.
● Anticholinergic Effects: Dry mouth, blurred vision, constipation, and urinary retention
can occur.
● Orthostatic Hypotension: Sudden drops in blood pressure upon standing, leading to
dizziness or fainting.
● Poor Adherence: Due to side effects and lack of insight into the illness.
Counseling Interventions:
● Psychoeducation: Educate the patient and family about schizophrenia, treatment options,
and the importance of adherence.
● Monitoring: Regularly assess for side effects and effectiveness of the medication.
● Supportive Therapy: Address concerns, build trust, and encourage open
communication.
● Behavioral Strategies: Implement routines and reminders to aid medication adherence.
● Referral: Collaborate with psychiatrists for medication adjustments if side effects are
intolerable.
Question 2
A) Five Routes of Drug Administration [5 Marks]
1. Oral (PO): Medication taken by mouth, e.g., tablets, capsules.
2. Intramuscular (IM): Injection into a muscle, e.g., antipsychotic depot injections.
3. Intravenous (IV): Injection directly into the bloodstream, e.g., emergency medications.
4. Subcutaneous (SC): Injection into the tissue beneath the skin, e.g., insulin.
5. Rectal: Medication administered via the rectum, e.g., suppositories for patients unable to
take oral medications.
B) Management of Hebephrenic Schizophrenia
i. Antipsychotic Choices and Rationale [5 Marks]
● Risperidone: An atypical antipsychotic effective in treating both positive and negative
symptoms of schizophrenia with a lower risk of EPS.
● Haloperidol: A typical antipsychotic useful for acute agitation and available in
long-acting injectable forms for maintenance therapy.
Question 2 (continued)
B) Management of Hebephrenic Schizophrenia (continued)
ii. Side Effects of Antipsychotics [continued]
● Risperidone:
○ Weight gain.
○ Increased prolactin levels (can lead to galactorrhea, amenorrhea, and sexual
dysfunction).
○ Sedation.
○ Extrapyramidal symptoms (at higher doses).
● Haloperidol:
○ High risk of extrapyramidal side effects (e.g., dystonia, parkinsonism, akathisia).
○ Tardive dyskinesia with long-term use.
○ QT prolongation (risk of arrhythmia).
○ Neuroleptic malignant syndrome (rare but life-threatening).
○ Sedation and restlessness.
iii. Role of Family in Management [5 Marks]
The family plays a vital role in the treatment and rehabilitation of individuals with hebephrenic
schizophrenia (also called disorganized schizophrenia). Their support helps improve outcomes
and reduce relapse rates.
1. Emotional Support:
○ Continuous reassurance, love, and patience are crucial.
○ Helps the patient manage feelings of loneliness or social isolation.
2. Monitoring Symptoms:
○ Family members often notice early signs of relapse and can seek medical help
quickly.
3. Medication Adherence:
○ Encouraging the patient to stick to their medication schedule.
○ Supervising intake when needed.
4. Psychoeducation:
○ Educating the family about the illness helps reduce stigma and improves empathy.
○ When families understand the biological basis of schizophrenia, blame and
frustration reduce.
5. Crisis Management:
○ Assisting during acute episodes by maintaining safety and seeking emergency
help.
○ Creating a stable and structured environment to prevent stress-induced relapses.
6. Encouraging Rehabilitation:
○ Helping the patient with daily activities, occupational therapy, and social
reintegration.
Example:
If a 25-year-old patient with hebephrenic schizophrenia stops bathing and starts speaking
incoherently, the family can alert the healthcare team promptly. They might also help with
reminders to take risperidone daily, attend follow-up appointments, and participate in social
skills training.
Question 2C. Which Category of Patients Do We Put on Long-Acting Anti-Psychotic
Drugs? Explain.
[5 Marks]
Answer:
Long-acting antipsychotic drugs, also known as depot injections, are given to patients who:
1. Have a history of non-adherence to oral medications:
○ These are often patients with poor insight into their condition or who forget or
refuse to take daily medication.
2. Experience frequent relapses:
○ Especially if these relapses are due to stopping oral medications. Long-acting
medications ensure consistent plasma drug levels and prevent sudden drops that
can cause relapse.
3. Have chronic schizophrenia:
○ Patients who need long-term maintenance therapy and have difficulty maintaining
daily treatment.
4. Live in unstable environments or have limited supervision:
○ For instance, homeless or institutionalized patients may benefit because the
medication is administered by health workers regularly (e.g., every 2–4 weeks).
5. Have a preference for fewer doses:
○ Some patients prefer injections every few weeks rather than taking daily pills.
Example:
A patient with paranoid schizophrenia who frequently stops taking risperidone due to delusions
that the medicine is poisoned may be placed on a depot risperidone injection to improve
adherence.
Question 2D. How Can Medication Adherence Be Improved?
[5 Marks]
Answer:
Medication adherence is essential in mental health care. To improve it:
1. Psychoeducation:
○ Educate the patient and their family about the illness, benefits of the medication,
side effects, and the importance of adherence. This reduces stigma and fear.
○ Example: Explain that antipsychotics reduce hallucinations and prevent relapses.
2. Simplifying the regimen:
○ Use once-daily dosing or long-acting formulations to reduce the burden of taking
many pills.
3. Building Therapeutic Alliance:
○ Establish a trusting relationship with the patient so they feel supported and
respected.
○ Involve them in decision-making regarding their treatment.
4. Reminders and Tools:
○ Use phone alerts, pillboxes, or involve caregivers to remind the patient to take
their medications.
5. Managing Side Effects:
○ Promptly treat or switch medications if the patient experiences distressing side
effects, which often lead to discontinuation.
Example:
A patient who stopped taking haloperidol due to tremors may be given trihexyphenidyl (an
anticholinergic) to manage side effects, encouraging them to resume treatment.
Question 3A
i) What do you think is happening to your client?
[5 Marks]
Answer:
Your client is likely experiencing acute dystonia, which is a type of extrapyramidal side effect
(EPS). It’s a sudden, involuntary muscle contraction that often occurs shortly after starting or
increasing the dose of typical (first-generation) antipsychotic medications, like haloperidol or
fluphenazine.
Clinical signs observed:
● Tongue protrusion
● Eye rolling upward (oculogyric crisis)
● Neck twisting to one side (torticollis)
● Excessive salivation
These are classical features of acute dystonic reaction, which can be frightening for both the
client and the observer but is typically reversible with prompt treatment.
Cause:
Blockade of dopamine D2 receptors in the nigrostriatal pathway of the brain, leading to an
imbalance between dopamine and acetylcholine.
ii) Mention 2 anticholinergic drugs possibly to be used to control the observation made.
[5 Marks]
Answer:
Two anticholinergic drugs that are commonly used to treat acute dystonia include:
1. Biperiden (Akineton):
○ Fast-acting anticholinergic, often administered IM or IV during acute dystonic
reactions.
○ Onset of action: within minutes.
2. Benztropine (Cogentin):
○ Can be administered orally or IM.
○ Restores the dopamine-acetylcholine balance in the basal ganglia.
Other examples (if needed):
● Procyclidine (Kemadrin)
● Trihexyphenidyl (Artane) – often used for maintenance to prevent future dystonia.
Example:
If the client was recently started on haloperidol and presents with oculogyric crisis and neck
stiffness, immediate IM administration of biperiden will usually reverse symptoms within 15
minutes.
Question 3B.
O.S has been taking Tab Olanzapine 20mg 12hly for the past seven days.
Critically analyse the prescription for its correctness or otherwise.
[5 Marks]
Answer:
The prescription of Olanzapine 20mg every 12 hours (i.e., 40mg daily) is not correct and is
potentially dangerous.
Reasons:
1. Maximum Recommended Dose:
○ The recommended maximum dose for olanzapine is 20mg per day.
○ Giving 40mg/day doubles the limit, increasing the risk of serious side effects.
2. Increased Risk of Side Effects:
○ High doses can lead to excessive sedation, weight gain, metabolic syndrome,
and increased risk of neuroleptic malignant syndrome.
3. Standard Dosage Practice:
○ Olanzapine is usually prescribed once daily, due to its long half-life (~30 hours),
which allows for sustained plasma levels.
Conclusion:
● This prescription is inappropriate. The dosage should be reviewed and reduced
immediately to avoid adverse effects.
Example of correct dosing:
● Olanzapine 10mg at night, increased to a maximum of 20mg/day if needed, depending on
response and tolerance.
Question 3C (i): Explain the characteristics of an ideal antipsychotic drug
[5 Marks]
Answer:
An ideal antipsychotic drug should have the following characteristics:
1. Effective Against Both Positive and Negative Symptoms:
○ It should reduce hallucinations and delusions (positive symptoms) as well as
apathy and social withdrawal (negative symptoms).
○ Example: Clozapine and Risperidone are better at treating both types.
2. Minimal Side Effects:
○ Should have a low risk of extrapyramidal symptoms (EPS), metabolic syndrome,
sedation, and cardiac issues.
○ Olanzapine, although effective, causes weight gain. Aripiprazole is better
tolerated.
3. Long Half-Life:
○ Allows for once-daily dosing, improving compliance.
○ Example: Paliperidone can be administered once monthly as an injection.
4. Good Bioavailability and Absorption:
○ Ensures the drug reaches therapeutic levels without needing very high doses.
5. Affordable and Accessible:
○ Especially in low-resource settings, affordability is crucial for adherence.
Question 3C (ii): How do you prevent medication errors?
[5 Marks]
Answer:
Medication errors can be prevented through the following strategies:
1. The “5 Rights” of Drug Administration:
○ Right patient, right drug, right dose, right time, right route.
2. Clear Prescriptions:
○ Avoid abbreviations like “u” for units, or unclear handwriting. Use electronic
prescribing when possible.
3. Double-checking Medications:
○ Especially high-risk drugs (e.g., insulin, antipsychotics) should be verified by a
second health professional.
4. Patient Education:
○ Teach the patient the name, purpose, dose, and timing of their medications.
5. Monitoring for Side Effects:
○ Early detection and reporting of side effects help in adjusting or stopping the drug
before harm occurs.
Example:
A nurse should clarify a prescription that says “Olanzapine 20mg 12hrly” with the prescriber,
since it exceeds the recommended dose.
Question 3D: Write the full meaning of the following medical abbreviations
[5 Marks]
Abbreviation Full Meaning
P.O Per Os (by mouth/orally)
IM Intramuscular
CAP Capsule
TAB Tablet
QID Quater in die (four times daily)
TID Ter in die (three times daily)
BD Bis in die (twice daily)
NOCTE At night
MANE In the morning
Question 4
Ai) Mention 2 antidepressant drugs suitable for Naomi’s condition and give reasons for
your choice.
[2 Marks]
Answer:
Two suitable antidepressant drugs for Naomi’s depression are:
1. Fluoxetine (Prozac) – a Selective Serotonin Reuptake Inhibitor (SSRI):
○ It’s commonly used in young adults.
○ Fewer side effects compared to older antidepressants.
○ Helps regulate mood by increasing serotonin levels in the brain.
2. Sertraline (Zoloft) – another SSRI:
○ Effective in treating moderate to severe depression.
○ Well-tolerated and safe, especially in outpatient care settings.
ii) Explain 5 side effects of the drugs mentioned above.
[5 Marks]
1. Nausea and Gastrointestinal Upset:
○ Common during the first few days; usually improves with time.
2. Sleep Disturbances:
○ Some patients report insomnia, while others feel drowsy.
3. Sexual Dysfunction:
○ Reduced libido or delayed orgasm is common with SSRIs.
4. Weight Changes:
○ Can cause weight gain or loss depending on individual metabolism.
5. Increased Anxiety Initially:
○ In the first 1–2 weeks, some patients feel more anxious before improvement
starts.
iii) What will be the effect of the drugs mentioned on Naomi’s mood?
[2 Marks]
Answer:
SSRIs like Fluoxetine and Sertraline elevate mood, reduce sadness, and restore Naomi’s energy
and interest in life. They work by increasing serotonin levels, which helps regulate emotions,
appetite, and sleep. Improvement usually begins within 2–4 weeks, though full effects may take
6–8 weeks.
B. Write short notes on the following:
[4 Marks]
i. Pharmacokinetics:
This refers to what the body does to a drug. It includes:
● Absorption (how it enters the bloodstream),
● Distribution (how it spreads through the body),
● Metabolism (how the liver breaks it down),
● Excretion (how it leaves the body, often via urine or stool).
Example: Olanzapine is metabolized by the liver and excreted in urine.
ii. Pharmacodynamics:
This refers to what the drug does to the body.
● It includes how the drug binds to receptors, how it affects neurotransmitters, and its
therapeutic and side effects.
Example: Antidepressants increase serotonin to improve mood.
C. Explain the three (3) types of prescription with one example each
[6 Marks]
1. Stat Prescription:
○ Given immediately in an emergency.
○ Example: “Diazepam 10mg stat” for seizures.
2. PRN (Pro Re Nata) Prescription:
○ Given as needed.
○ Example: “Paracetamol 500mg PRN for pain.”
3. Routine Prescription:
○ Given on a regular schedule (e.g., daily).
○ Example: “Sertraline 50mg daily.”
D. Mention five (5) sources of drugs
[5 Marks]
1. Natural Sources:
○ Example: Morphine from opium poppy.
2. Plant Sources:
○ Example: Digoxin from foxglove plant.
3. Animal Sources:
○ Example: Insulin from pig or cow pancreas (though now mostly synthetic).
4. Microbial Sources:
○ Example: Penicillin from Penicillium fungus.
5. Synthetic/Man-made Sources:
○ Example: Paracetamol, created in labs.
E. Explain the two types of ECT to a client who you are preparing to undergo ECT
procedure
[6 Marks]
1. Bilateral ECT:
● Electrodes are placed on both sides of the head.
● More effective in severe depression but may cause more memory problems.
● Example: Used when quick response is needed, like suicidal ideation.
2. Unilateral ECT:
● Electrodes are placed on one side of the head (usually the non-dominant side).
● Fewer cognitive side effects, though it may be slightly less effective.
● Preferred when long-term memory function is a concern.
During ECT, the patient is under general anesthesia and a muscle relaxant is used to prevent
injury. The entire process takes a few minutes.
Question 5
A(i). Give one advantage of Oral Drug Administration.
[5 Marks]
Answer:
One major advantage of oral drug administration is its convenience and safety.
● It’s non-invasive, meaning no needles or special equipment are required.
● It's easy to self-administer, especially useful for chronic conditions.
● Example: A patient can easily take Fluoxetine capsules at home once daily without
supervision.
It also allows for slow, steady absorption, which is ideal for maintaining stable drug levels in
the body.
A(ii). Give one disadvantage of Oral Route of Drug Administration.
[5 Marks]
Answer:
A key disadvantage is that it depends heavily on the patient's gastrointestinal function.
● If a patient is vomiting, unconscious, or has poor gut absorption (e.g., due to Crohn’s
disease), the oral route becomes ineffective.
● Some drugs are also destroyed by stomach acid or enzymes before they can be
absorbed.
Example: Insulin cannot be given orally because it would be broken down in the stomach; it
must be injected.
B) Mention and explain five (5) sources of medication errors.
[5 Marks]
1. Poor Handwriting on Prescriptions:
○ Misinterpreting “Mg” as “Mcg” can lead to overdosing.
2. Similar Drug Names:
○ Confusing Clonidine with Clonazepam due to similar names.
3. Lack of Communication:
○ When doctors, nurses, or pharmacists fail to update each other about drug
changes.
4. Wrong Route of Administration:
○ Giving a drug meant for intravenous (IV) use orally can cause poor effect or
harm.
5. Wrong Dosage Calculation:
○ Especially in pediatric or geriatric patients, miscalculation based on weight or age
can be fatal.
C) Provide the Generic Name for the under Listed Anti-Psychotic Drugs
(Since the list wasn’t included, I’ll assume a common set of examples. If you have a specific list,
let me know and I’ll tailor it.)
1. Zyprexa – Olanzapine
2. Risperdal – Risperidone
3. Seroquel – Quetiapine
4. Haldol – Haloperidol
5. Abilify – Aripiprazole
6. Clozaril – Clozapine
7. Thorazine – Chlorpromazine
8. Loxapac – Loxapine
