Organic mental disorders: anticholinergic delirium in the elderly: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Organic mental disorders: anticholinergic delirium in the elderly

Sample item

A 78-year-old man with depression started a tricyclic antidepressant and develops constipation, urinary retention and acute confusion. Which drug is the likely cause?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Amitriptyline

Amitriptyline has strong anticholinergic action, so in the elderly it can cause delirium, retention, constipation and falls. SSRIs and mirtazapine have little anticholinergic effect and are preferred. This is why tricyclics are avoided in older people.

Option by option

  • A. Escitalopram

    Escitalopram has minimal anticholinergic effect.

  • B. Amitriptyline (correct)

    Correct. Strong muscarinic blockade explains confusion, retention and constipation.

  • C. Mirtazapine

    Mirtazapine has weak anticholinergic action and mainly causes sedation and weight gain.

  • D. Sertraline

    Sertraline has negligible anticholinergic activity.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Amitriptyline. Amitriptyline has strong anticholinergic action, so in the elderly it can cause delirium, retention, constipation and falls.

Why is "Escitalopram" not the answer?

Escitalopram has minimal anticholinergic effect.

Why is "Mirtazapine" not the answer?

Mirtazapine has weak anticholinergic action and mainly causes sedation and weight gain.

Why is "Sertraline" not the answer?

Sertraline has negligible anticholinergic activity.

What concept does this question test?

It tests Organic mental disorders: anticholinergic delirium in the elderly in Psychiatry. SSRIs and mirtazapine have little anticholinergic effect and are preferred. This is why tricyclics are avoided in older people.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Organic mental disorders: anticholinergic delirium in the elderly?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.