Psychopharmacology: anticholinergic misuse: 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 · Psychopharmacology: anticholinergic misuse

Sample item

A man with schizophrenia on haloperidol repeatedly demands extra tablets of his anti-parkinsonian drug, saying it makes him feel pleasantly high and relaxed, though he has no tremor or stiffness. Which drug is most likely to be misused in this way?

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

The answer and the reasoning

A. Trihexyphenidyl

Trihexyphenidyl and other central anticholinergics can produce euphoria and mild hallucinations in higher doses, and they are misused by some patients. Prescribers should use them only when needed and for short periods.

Option by option

  • A. Trihexyphenidyl (correct)

    Correct. Central anticholinergics have recognised misuse potential.

  • B. Mirtazapine

    Mirtazapine is sedating but not an agent of misuse in this fashion.

  • C. Propranolol

    Propranolol does not produce euphoria and has no misuse potential.

  • D. Lithium

    Lithium has a narrow therapeutic index and is not sought for euphoria.

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 A, Trihexyphenidyl. Trihexyphenidyl and other central anticholinergics can produce euphoria and mild hallucinations in higher doses, and they are misused by some patients.

Why is "Mirtazapine" not the answer?

Mirtazapine is sedating but not an agent of misuse in this fashion.

Why is "Propranolol" not the answer?

Propranolol does not produce euphoria and has no misuse potential.

Why is "Lithium" not the answer?

Lithium has a narrow therapeutic index and is not sought for euphoria.

What concept does this question test?

It tests Psychopharmacology: anticholinergic misuse in Psychiatry. Prescribers should use them only when needed and for short periods.

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 Psychopharmacology: anticholinergic misuse?

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.