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Answer 4
  1. Agranulocytosis. This patient’s history of schizophrenia (previously refractory to treatment), now stabilized on a single agent requiring frequent blood draws, suggests that he is likely receiving clozapine. This agent is frequently used for patients in whom other antipsychotic agents have failed. However, clozapine use is associated with potentially fatal agranulocytosis in a small number of patients.2 Depending on the severity of agranulocytosis, clozapine treatment may need to be stopped immediately.2Streptococcal pharyngitis is possible whether or not agranulocytosis exists, but it is not immediately life-threatening. The patient is not exhibiting symptoms of dystonia or anticholinergic toxicity. Lithium monotherapy is not indicated for schizophrenia.2

    2. American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. 2nd ed. American Psychiatric Association practice guidelines for the treatment of psychiatric disorders compendium 2002. Washington (DC): The Association; 2002:349-461.

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