Antipsychotics — cross-table viva

Station structure

Time: 8–10 minutes. Depth: consultant teaching registrar. Expect pathway maps, trial one-liners, and safe prescribing without marketing slogans.[3]

Core questions and model points

1. Map four dopamine pathways to clinical effects. Mesolimbic efficacy; mesocortical secondary negatives; nigrostriatal EPS; tuberoinfundibular prolactin.[3]

2. What did CATIE and CUtLASS change? Real-world effectiveness and QoL challenges to blanket SGA superiority; metabolic trade-offs matter.[1][2]

3. Where does clozapine sit in Leucht NMA and TRRIP? Highest efficacy rank; indicated after two adequate failed trials in TRS framework.[3][4]

4. InterSePT one-liner. Clozapine reduces suicidality vs olanzapine in high-risk schizophrenia.[5]

5. Prescribe safely. Baseline metabolic/ECG package; early review; no IM olanzapine + parenteral BZD — safety is part of the same evidence conversation as efficacy.[3]

Pass criteria

• Pathway–side-effect mapping accurate against standard dopamine pathway teaching.[3]
• Landmark trial take-home correct (not memorised p-values alone): CATIE/CUtLASS effectiveness realism, Leucht comparative ranking, TRRIP clozapine threshold, InterSePT suicidality.[1][2][3][4][5]
• TRS → clozapine pathway clear after two adequate trials.[4]
• Safety monitoring automatic in speech.[3]