16 Questions
What is the recommended first-line treatment option for the agitated patient in the second case?
Haloperidol and lorazepam IM
What is the college student's belief about the WiFi signal in his dorm room?
The WiFi signal is sending him special messages to control his behavior
What is the college student's concerning behavior regarding his drinking?
He only drinks bottled water because he believes people will put something in his regular drinks
What is the best first step in the pharmacologic treatment of the 24-year-old man with chronic schizophrenia described in the text?
Haloperidol
What disorder is most likely in the 54-year-old man with chronic mental illness who exhibits constant chewing, tongue darting, lip smacking, grimacing, frowning, and excessive blinking?
Parkinson disease
Which medication is most likely to have caused the irregular choreoathetoid movements in the 58-year-old woman with a chronic mental disorder?
Clozapine
If the 24-year-old man had been given Lithium instead of Haloperidol, what could be a possible consequence?
Worsening of confusion
What distinguishes tardive dyskinesia from Tourette disorder in terms of symptoms?
Presence of motor and vocal tics
What differentiates akathisia from Parkinson disease in terms of symptoms?
Improvement with physical activity
What is the most likely cause of the 24-year-old man's elevated temperature and muscle rigidity?
Neuroleptic malignant syndrome
What is the most appropriate initial pharmacologic treatment for the 24-year-old man with suspected neuroleptic malignant syndrome?
Bromocriptine
Which of the following is the most likely diagnosis for the 54-year-old man with constant chewing, tongue darting, lip smacking, and other involuntary movements?
Tardive dyskinesia
What is the most likely cause of the irregular choreoathetoid movements in the 58-year-old woman with a chronic mental disorder?
Perphenazine
Which of the following is the most likely cause of the 54-year-old man's involuntary movements?
Excessive dopamine activity
What is the most likely underlying cause of the irregular choreoathetoid movements in the 58-year-old woman?
Long-term use of antipsychotic medications
What is the most appropriate first-line pharmacologic intervention for the 24-year-old man with suspected neuroleptic malignant syndrome?
Dopamine agonists
Study Notes
Schizophrenia and Other Psychotic Disorders
- A 19-year-old woman with schizophrenia may exhibit symptoms such as hoarding food, talking to herself, and appearing paranoid.
- Features indicative of a poor prognosis in schizophrenia include late onset, lack of clear precipitating factors, lack of social support, family history of mood disorders, and presence of negative symptoms.
Treatment of Psychotic Disorders
- Haloperidol and lorazepam may be administered intramuscularly as a first-line treatment for agitated patients with psychotic symptoms.
- Clozapine may be used as a treatment option if there is a minimal response to other antipsychotic medications.
Diagnosis of Psychotic Disorders
- A patient experiencing depression, delusions, and hallucinations may be diagnosed with schizoaffective disorder or major depressive disorder with psychotic features.
- Delusional disorder involves non-bizarre delusions in the absence of other psychotic symptoms.
Neuroleptic Malignant Syndrome
- Neuroleptic malignant syndrome is a rare and life-threatening side effect of antipsychotic medications, characterized by muscle rigidity, elevated temperature, and altered mental status.
- The best first step in pharmacologic treatment of neuroleptic malignant syndrome is to stop the antipsychotic medication and provide supportive care.
Tardive Dyskinesia
- Tardive dyskinesia is a movement disorder caused by long-term use of antipsychotic medications, characterized by involuntary movements of the face, tongue, and limbs.
- Medications such as perphenazine and clozapine may cause tardive dyskinesia.
- Fluoxetine and diazepam are not typically associated with tardive dyskinesia.
Akathisia
- Akathisia is a movement disorder caused by antipsychotic medications, characterized by restlessness, fidgeting, and anxiety.
- Medications such as perphenazine may cause akathisia.
Test your knowledge on the pharmacologic treatment of schizophrenia and other psychotic disorders by answering a clinical case scenario question. Identify the best first step in the pharmacologic management of a 24-year-old man with chronic schizophrenia presenting with confusion, disorientation, severe muscle rigidity, and fever.
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