PSYCHIATRY EDUCATION FORUM ACADEMY'S LECTURE SERIES:

Let’s begin by answering these questions first:

Question 1

Q: Ideally TCAs should be avoided with angle closure glaucoma, but if you have to choose: which of the following TCA is the preferred one in patients with history or at-risk of angle closure glaucoma?

Question: 2

Q: "Down Beat Nystagmus" is common with mood stabilizer toxicity, but which of the following mood stabilizer is also associated with "Lateral Nystagmus"?

Question 3:

Q: Which of the following medication is shown to cause Alice in Wonderland syndrome (Dysmetropsia)

Answers:

Answer to Q1: (c) Nortriptyline

Prefer TCAs with low affinity for the muscarinic receptors

  • Amitriptyline and Doxepin had the greatest anticholinergic potency,
  • Nortriptyline, Imipramine, and Desipramine bound with relatively less affinity to the muscarinic receptor.

Answer to Q2: (b) Carbamazepine

  • Likely Mechanism: through inhibition of voltage-dependent sodium channels.
  • commonly result in diplopia and gaze-evoked nystagmus.

Answer to Q3: (c) Topiramate

  • Clinical Symptoms: experiencing distortions in visual perception of objects, example: objects appearing smaller (micropsia) or larger (macropsia), or closer (pelopsia) or farther (teleopsia).

Psychotropics can have ocular adverse events, which are negative effects on the eyes and vision. Some common ocular adverse events associated with psychotropics include:

  • Dry eyes: Many psychotropics can cause dry eyes, which can lead to itching, burning, and discomfort.
  • Blurred vision: Some psychotropics can cause blurred vision, which can be temporary or permanent.
  • Light sensitivity: Some psychotropics can cause light sensitivity, which can make it difficult to see in bright light.
  • Nystagmus: Nystagmus is an involuntary eye movement that can be caused by certain psychotropics.
  • Accommodation disorders: Some psychotropics can cause accommodation disorders, which can make it difficult to focus the eyes.
  • Glaucoma: Some psychotropics can increase the risk of developing glaucoma, a condition that can cause vision loss.

It’s important to note that not all psychotropics will cause ocular adverse events and that the severity and frequency of these events can vary from person to person.

 

This lecture series will summarize this clinically relevant topic in the following 15 chapters:

TABLE OF CONTENT

(A) ANGLE CLOSURE GLAUCOMA

(1) Angle Closure Glaucoma: Symptoms, Risk-Factors & Prevention

(2) Angle Closure Glaucoma & ANTIDEPRESSANTS

(3) Angle Closure Glaucoma & OTHER PSYCHOTROPICS

(4) ECT in the setting of Glaucoma

(b) UVEAL TRACT DISORDERS

(1) Tricyclic Antidepressants

(2) Topiramate

(3) SSRIs 

(4) Antipsychotics

(3) IMPAIRED EYE MOVEMENTS (NYSTAGMUS)

(1) Nystagmus & Psychotropics

(4) OTHER OCULAR ADVERSE EVENTS

(1) Epithelial Keratopathy

(2) Allergic Conjunctivitis

(3) Alice in Wonderland syndrome (Dysmetropsia)

(4) Exophthalmos and Papilledema

(5) Palinopsia

(6) Eye Irritation

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