Question 1

Questions 1-3 Refer to the Following Case:

A 45-year-old former bank executive presents to a neurologist after being discharged from a subacute inpatient facility 6 months after he received a severe closed head injury in a motor vehicle accident. He is able to ambulate independently but continues to have residual difficulties with functional use of his right hand, distractibility, disorganization, and poor longterm memory as well as irritability and anger outbursts. The patient’s anger outbursts are occasionally violent and can seem unprovoked, but they tend to be triggered by episodes where others point out information that he was told but cannot remember.


The patient is reportedly less likely to have severe behavioral outbursts since he was prescribed ß blockers and neuroleptics. He is also taking an antiepileptic medication, a cholinesterase inhibitor, and a serotonin-norepinephrine reuptake inhibitor. A ccording to family members, his recovery course seems to have reached a plateau. The family asks why he seemed to become more disorganized 2 months ago, showing reduced initiation and follow-through in his actions, with no signs of improvement since then. Which combination of the patient’s current medications would be most concerning for contributing to these symptoms?