Drugs in Psychiatric Disorders — MCQs

Q: Which of the following drugs has the highest potential to cause metabolic syndrome?

Clozapine. **Explanation:** Metabolic syndrome—characterized by significant weight gain, hyperlipidemia, and hyperglycemia (Type 2 Diabetes)—is a major adverse effect of **Second-Generation Antipsychotics (SGAs)**. **1. Why Clozapine is correct:** Clozapine (along with Olanzapine) carries the **highest risk** of metabolic syndrome. The underlying mechanism involves potent antagonism of **H1 (histamine)** and **5-HT2C (serotonin)** receptors, which leads to increased appetite, sedation, and direct interference with insulin sensitivity. Clozapine is associated with the most profound weight gain and the highest incidence of new-onset diabetes among all antipsychotics. **2. Analysis of incorrect options:** * **Quetiapine:** Also carries a high risk of metabolic syndrome, but it is clinically ranked lower than Clozapine and Olanzapine. * **Risperidone:** Carries a moderate risk. It is more notorious for causing hyperprolactinemia (due to D2 blockade in the tuberoinfundibular pathway) than severe metabolic derangement. * **Aripiprazole:** This is a partial D2 agonist and has the **lowest risk** (metabolically neutral) along with Ziprasidone and Lurasidone. **3. NEET-PG High-Yield Pearls:** * **Hierarchy of Metabolic Risk:** Clozapine = Olanzapine > Quetiapine > Risperidone > Aripiprazole = Ziprasidone. * **Monitoring:** Patients on Clozapine require mandatory monitoring of BMI, fasting blood glucose, and lipid profiles. * **Clozapine "Must-Knows":** It is the drug of choice for **resistant schizophrenia**, but its use is limited by **agranulocytosis** (requires regular CBC monitoring) and a lowered seizure threshold.

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Drugs for Sleep Disorders

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