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Self-Assessment Questions


Evaluation and Treatment of Psychosis: Review Questions

William R. Marchand, MD
Dr.Marchand is an assistant professor of psychiatry, University of Utah School of Medicine, Salt Lake City, UT.

Choose the single best answer for each question.

1. A 23-year-old man reports muscle stiffness, diaphoresis, and fever. He states that he was diagnosed with schizophrenia recently and started on oral haloperidol. Physical examination reveals muscle rigidity, hypertension, and tachycardia. Laboratory studies are remarkable for leukocytosis and elevated creatine phosphokinase. The patient reports that his symptoms have improved with haloperidol. Which of the following would be the most appropriate option for this patient?
  1. Change to haloperidol decanoate injections
  2. Discontinue haloperidol
  3. Increase the daily haloperidol dose by 10%-20%
  4. Start benztropine 0.5 mg twice daily and continue haloperidol
  5. Start lorazepam 1.0 mg twice daily and continue haloperidol
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2. How often should schizophrenic patients who are being treated with atypical antipsychotic agents be monitored for signs of tardive dyskinesia?

  1. Approximately every 3 months
  2. Monitoring is not necessary because tardive dyskinesia can be rapidly reversed by stopping the antipsychotic agent
  3. Never—tardive dyskinesia is not a side effect of atypical antipsychotic agents
  4. Once every year
  5. Once every year, but only for patients with a prior history of tardive dyskinesia
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3. A 35-year-old woman with paranoid schizophrenia presents to the emergency department with a recent increase in auditory hallucinations. She states that the voices are very disturbing, and she feels that her illness has ruined her life. She is single, lives alone, and is unemployed. Which of the following must be done before making any emergency treatment decisions?

  1. Assess for suicide risk
  2. Drug of abuse screen
  3. Magnetic resonance imaging of the brain
  4. Pregnancy test
  5. Spinal tap
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4. A 55-year-old man is brought to your office by his adult daughter. The daughter requests to speak with you alone. She states that her father believes that a well-known female celebrity is in love with him; however, he has never met the celebrity. The daughter states her father ³seems normal² otherwise. He works as an accountant and was recently promoted. What is this patient’s most likely diagnosis?
  1. Bipolar disorder
  2. Delusional disorder
  3. Major depression with psychotic features
  4. Schizoaffective disorder
  5. Schizophrenia
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5. A 65-year-old man presents to the emergency department with a sore throat, fever, and weakness. He states that he has schizophrenia. Further, he says that he has had trials of several antipsychotic medications that were not effective but is now on an agent that has completely controlled his symptoms. He cannot remember the name of his current medication but reports that he has to have his blood drawn frequently. He is not taking any medications other than the antipsychotic agent. Results of his mental status examination are normal. Which of the following is the most important diagnosis to rule out?

  1. Agranulocytosis
  2. Anticholinergic toxicity
  3. Dystonia
  4. Lithium toxicity
  5. Streptococcal pharyngitis
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