Psychotic Disorders

Psychotic Disorders US Medical PG Question 1: A 26-year-old man is brought to the emergency department by his wife because of bizarre and agitated behavior for the last 6 weeks. He thinks that the NSA is spying on him and controlling his mind. His wife reports that the patient has become withdrawn and at times depressed for the past 3 months. He lost his job because he stopped going to work 4 weeks ago. Since then, he has been working on an invention that will block people from being able to control his mind. Physical and neurologic examinations show no abnormalities. On mental status examination, he is confused and suspicious with marked psychomotor agitation. His speech is disorganized and his affect is labile. Which of the following is the most likely diagnosis?

• A. Brief psychotic disorder
• B. Schizophreniform disorder (Correct Answer)
• C. Schizotypal personality disorder
• D. Schizophrenia
• E. Delusional disorder

Psychotic Disorders Explanation: ***Schizophreniform disorder*** - The patient's symptoms, including **delusions** (fixed false beliefs that the NSA is spying and controlling his mind), **disorganized speech**, and **agitated behavior**, are consistent with a psychotic disorder. - The duration of active psychotic symptoms (6 weeks), which is more than 1 month but less than 6 months, fits the diagnostic criteria for **schizophreniform disorder**. - The prodromal phase (withdrawn and depressed for 3 months) plus the active phase does not yet meet the 6-month requirement for schizophrenia. *Brief psychotic disorder* - This disorder is characterized by a sudden onset of psychotic symptoms lasting less than 1 month, followed by a full return to premorbid functioning. - The patient's active psychotic symptoms have persisted for 6 weeks, exceeding the maximum duration for brief psychotic disorder. *Schizotypal personality disorder* - This disorder primarily involves a pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships, as well as cognitive or perceptual distortions and eccentricities. - While there might be odd beliefs or magical thinking, it does not typically involve the persistent and severe delusions and disorganized speech seen in this case. - This is a personality disorder, not a psychotic disorder. *Schizophrenia* - Schizophrenia requires continuous signs of disturbance for at least 6 months, which includes at least 1 month of active-phase symptoms (delusions, hallucinations, disorganized speech). - The patient's total duration of illness (3 months of prodromal symptoms plus 6 weeks of active symptoms) totals approximately 4.5 months, which is less than the 6-month minimum duration required for a diagnosis of schizophrenia. *Delusional disorder* - The primary feature of delusional disorder is the presence of one or more delusions for at least 1 month, without other prominent psychotic symptoms such as disorganized speech or behavior. - This patient exhibits prominent **disorganized speech**, **labile affect**, and **disorganized behavior** (bizarre invention work), which are not characteristic of delusional disorder. - Functioning is more impaired than typically seen in delusional disorder.

Psychotic Disorders US Medical PG Question 2: A 45-year-old obese man is evaluated in a locked psychiatric facility. He was admitted to the unit after he was caught running through traffic naked while tearing out his hair. His urine toxicology screening was negative for illicit substances and after careful evaluation and additional history, provided by his parents, he was diagnosed with schizophrenia and was treated with aripiprazole. His symptoms did not improve after several dosage adjustments and he was placed on haloperidol, but this left him too lethargic and slow and he was placed on loxapine. After several dosage adjustments today, he is still quite confused. He describes giant spiders and robots that torture him in his room. He describes an incessant voice screaming at him to run away. He also strongly dislikes his current medication and would like to try something else. Which of the following is indicated in this patient?

• A. Haloperidol
• B. Olanzapine
• C. Chlorpromazine
• D. Fluphenazine
• E. Clozapine (Correct Answer)

Psychotic Disorders Explanation: ***Clozapine*** - This patient has **treatment-resistant schizophrenia**, indicated by a lack of response to multiple trials of antipsychotics, including aripiprazole (atypical), haloperidol (typical), and loxapine (atypical). - **Clozapine** is the only antipsychotic proven effective for treatment-resistant schizophrenia, significantly reducing psychotic symptoms and suicidality. *Haloperidol* - Haloperidol is a **first-generation antipsychotic** that the patient has already tried and found to be too sedating and slow. - Continuing with haloperidol would likely result in persistent side effects and inadequate symptom control given his prior negative experience. *Olanzapine* - Olanzapine is a **second-generation atypical antipsychotic**; however, it is not typically indicated as a first-line treatment for treatment-resistant schizophrenia after failure of multiple agents. - While effective for schizophrenia, it would be less effective than clozapine in a patient who has failed several previous antipsychotic trials. *Chlorpromazine* - Chlorpromazine is a **first-generation antipsychotic** that carries a higher risk of sedation, extrapyramidal symptoms, and anticholinergic side effects. - It is unlikely to be more effective than haloperidol, which the patient already found too sedating and slow, and would not be the preferred choice for treatment-resistant schizophrenia. *Fluphenazine* - Fluphenazine is a **first-generation antipsychotic** with potent dopamine D2 receptor blockade, often leading to significant extrapyramidal side effects. - Like other first-generation antipsychotics, it is not indicated as the next step for treatment-resistant schizophrenia after failure of multiple trials.

Psychotic Disorders US Medical PG Question 3: A 24-year-old man is brought to your emergency department under arrest by the local police. The patient was found naked at a busy intersection jumping up and down on top of a car. Interviewing the patient, you discover that he has not slept in 2 days because he does not feel tired. He reports hearing voices. The patient was previously hospitalized 1 year ago with auditory hallucinations, paranoia, and a normal mood. What is the most likely diagnosis?

• A. Schizophrenia
• B. Bipolar disorder
• C. Brief psychotic disorder
• D. Schizotypal disorder
• E. Schizoaffective disorder (Correct Answer)

Psychotic Disorders Explanation: ***Schizoaffective disorder*** - This patient demonstrates the **hallmark feature** of schizoaffective disorder: **psychotic symptoms occurring both during AND independent of mood episodes**. - **Current presentation**: Clear **manic episode** (decreased need for sleep, grandiose/disinhibited behavior, psychomotor agitation) with psychotic features (auditory hallucinations). - **Previous hospitalization**: **Psychotic symptoms (hallucinations, paranoia) in the absence of a mood episode** ("normal mood"), requiring hospitalization for at least 2 weeks - this is the **key diagnostic criterion** for schizoaffective disorder. - The diagnosis requires an **uninterrupted period of illness** with both psychotic symptoms (meeting Criterion A for schizophrenia) and a major mood episode, PLUS psychotic symptoms for **≥2 weeks without prominent mood symptoms**. *Bipolar disorder* - In bipolar disorder with psychotic features, psychotic symptoms occur **exclusively during mood episodes** (manic, hypomanic, or depressive). - This patient's previous hospitalization with psychosis but **"normal mood"** indicates psychotic symptoms independent of mood episodes, which **rules out** bipolar disorder and points to schizoaffective disorder. - While the current presentation shows mania with psychosis, the longitudinal course is critical for diagnosis. *Schizophrenia* - Schizophrenia involves **continuous psychotic symptoms** without prominent mood episodes dominating the clinical picture. - This patient has **prominent manic symptoms** (decreased sleep, grandiose behavior, agitation) that are central to the current presentation, making schizophrenia less likely. - The presence of full mood episodes that occupy a **substantial portion** of the illness duration favors schizoaffective disorder over schizophrenia. *Brief psychotic disorder* - Brief psychotic disorder involves psychotic symptoms lasting **<1 month** with full return to baseline functioning. - This patient has a **recurrent course** with hospitalization 1 year ago, indicating a chronic/recurring condition rather than a brief, self-limited episode. *Schizotypal disorder* - This is a **personality disorder** characterized by social deficits, cognitive/perceptual distortions, and eccentric behavior, but **NOT overt psychotic episodes**. - Does not involve acute psychotic breaks with severe symptoms like hallucinations requiring hospitalization or manic episodes.

Psychotic Disorders US Medical PG Question 4: A 21-year-old man presents to the emergency room requesting surgery to remove "microchips," which he believes were implanted in his brain by "Russian spies" 6 months ago to control his thoughts. He also reports hearing the "spies" talk to each other through embedded "microspeakers." You notice that his hair appears unwashed and some of his clothes are on backward. Urine toxicology is negative for illicit drugs. Which of the following additional findings are you most likely to see in this patient during the course of his illness?

• A. Anhedonia, guilty rumination, and insomnia
• B. Grandiose delusions, racing thoughts, and pressured speech
• C. Asociality, flat affect, and alogia (Correct Answer)
• D. Amnesia, multiple personality states, and de-realization
• E. Intrusive thoughts, ritualized behaviors, and anxious mood

Psychotic Disorders Explanation: ***Asociality, flat affect, and alogia*** - This patient exhibits **delusions (persecutory, control)** and **auditory hallucinations**, classic positive symptoms of **schizophrenia**. The question asks about findings "during the course of his illness," which points to the **typical progression of schizophrenia**: patients initially present with **positive symptoms** (as seen in this case) and **over time develop negative symptoms** such as **asociality** (lack of motivation to engage in social interaction), **flat affect** (reduced emotional expression), and **alogia** (poverty of speech). - The disorganized appearance (unwashed hair, clothes on backward) already demonstrates **disorganized behavior**, part of the schizophrenia spectrum. Negative symptoms typically emerge or worsen as the illness progresses, representing the most likely additional findings. *Anhedonia, guilty rumination, and insomnia* - While **anhedonia** and **insomnia** can be seen in schizophrenia, their presence alongside prominent **guilty rumination** would more strongly suggest a **depressive disorder with psychotic features**, rather than primary schizophrenia, especially with the patient's specific, classic psychotic symptoms. - The primary symptoms described (delusions of control, auditory hallucinations) are more characteristic of primary psychotic disorders, and guilty rumination is not a typical feature of schizophrenia progression. *Grandiose delusions, racing thoughts, and pressured speech* - These symptoms are hallmark features of **mania** or a **manic episode with psychotic features**. While psychotic features can occur in bipolar disorder with mania, the patient's specific delusions of being controlled by spies and hearing voices discussing him are more typical of schizophrenia. - The absence of information about elevated mood, increased energy, or decreased need for sleep also makes mania less likely compared to schizophrenia. *Amnesia, multiple personality states, and de-realization* - These symptoms are characteristic of **dissociative disorders**. **Amnesia** and **multiple personality states** (now known as identity alteration in dissociative identity disorder) involve disturbances in memory and identity. - **De-realization** involves feelings of unreality regarding one's surroundings. None of these align with the patient's primary presentation of well-formed delusions and hallucinations characteristic of a psychotic disorder. *Intrusive thoughts, ritualized behaviors, and anxious mood* - These are core features of **obsessive-compulsive disorder (OCD)**. The patient's symptoms are clearly defined as delusions (fixed false beliefs) and hallucinations (perceptions without external stimuli), which are distinct from the ego-dystonic intrusive thoughts and ritualistic compulsions of OCD. - While anxiety may be present in psychotic disorders, the primary presentation here is not dominated by OCD-like symptoms, and these would not be expected to develop as part of schizophrenia's natural course.

Psychotic Disorders US Medical PG Question 5: A 27-year-old man presents to the emergency department for bizarre behavior. The patient had boarded up his house and had been refusing to leave for several weeks. The police were called when a foul odor emanated from his property prompting his neighbors to contact the authorities. Upon questioning, the patient states that he has been pursued by elves for his entire life. He states that he was tired of living in fear, so he decided to lock himself in his house. The patient is poorly kempt and has very poor dentition. The patient has a past medical history of schizophrenia which was previously well controlled with olanzapine. The patient is restarted on olanzapine and monitored over the next several days. Which of the following needs to be monitored long term in this patient?

• A. CBC
• B. HbA1c levels (Correct Answer)
• C. ECG
• D. Monitoring for acute dystonia
• E. Renal function studies

Psychotic Disorders Explanation: ***HbA1c levels*** - **Olanzapine** is associated with significant metabolic side effects, including **weight gain**, **dyslipidemia**, and **new-onset diabetes mellitus**, necessitating long-term monitoring of **glucose metabolism** - **HbA1c** provides an average of blood glucose levels over the past 2-3 months, making it an excellent indicator for assessing the risk and progression of **diabetes** in patients on olanzapine. *CBC* - While some antipsychotics can cause hematological side effects like **agranulocytosis** (e.g., **clozapine**), **olanzapine** is not typically associated with severe bone marrow suppression requiring routine, long-term CBC monitoring. - CBC monitoring would be more relevant in the short-term if there were specific concerns for infection or adverse drug reactions. *ECG* - Some atypical antipsychotics can prolong the **QTc interval**, which would warrant ECG monitoring, but this adverse effect is less commonly associated with **olanzapine** compared to other antipsychotics like **ziprasidone** or **haloperidol**. - While a baseline ECG might be considered, long-term routine ECG monitoring is not typically indicated without specific cardiac risk factors or symptoms. *Monitoring for acute dystonia* - **Acute dystonia** is an extrapyramidal symptom that typically occurs early in treatment with antipsychotics, especially first-generation agents or at the initiation of therapy with second-generation agents like **olanzapine**. - While important to monitor acutely, it is not a long-term monitoring requirement once the patient is stable on the medication. *Renal function studies* - **Olanzapine** is primarily metabolized by the liver, and **renal excretion** plays a minor role in its elimination. - Therefore, long-term monitoring of renal function is not routinely recommended for patients on olanzapine unless there are pre-existing kidney conditions or other nephrotoxic medications.

Psychotic Disorders US Medical PG Question 6: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Psychotic Disorders Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Psychotic Disorders US Medical PG Question 7: A 45-year-old man presents to a psychiatrist by his wife with recent behavioral and emotional changes. The patient’s wife says that her husband’s personality has completely changed over the last year. She also says that he often complains of unpleasant odors when actually there is no discernible odor present. The patient mentions that he is depressed at times while on other occasions, he feels like he is ‘the most powerful man in the world.’ The psychiatrist takes a detailed history from this patient and concludes that he is most likely suffering from a psychotic disorder. However, before prescribing an antipsychotic medication, he recommends that the patient undergoes brain imaging to rule out a brain neoplasm. Based on the presence of which of the following clinical signs or symptoms in this patient is the psychiatrist most likely recommending this imaging test?

• A. Olfactory hallucinations (Correct Answer)
• B. Echolalia
• C. Anhedonia
• D. Delusions of grandeur
• E. Thought broadcasting

Psychotic Disorders Explanation: ***Olfactory hallucinations*** - The presence of **olfactory hallucinations** ("unpleasant odors when actually there is no discernible odor present") in the context of new-onset psychotic symptoms and personality changes, particularly in a middle-aged adult, raises suspicion for an underlying **structural brain lesion**, such as a **frontal or temporal lobe tumor**. - Brain neoplasms in these regions can irritate cortical areas, leading to atypical psychotic symptoms and these specific types of hallucinations, making imaging crucial before initiating antipsychotic therapy. *Echolalia* - **Echolalia** is the involuntary repetition of words or phrases spoken by another person, often associated with conditions like **autism spectrum disorder**, **Tourette's syndrome**, or severe **psychotic disorders**, particularly **schizophrenia**. - While it can be a feature of psychiatric illness, it is not a red flag for structural brain pathology in the same manner as new-onset olfactory hallucinations. *Anhedonia* - **Anhedonia** is the inability to experience pleasure from activities usually found enjoyable, a prominent symptom of **major depressive disorder** and other mood disorders, as well as some psychotic disorders. - Although the patient reports feeling "depressed at times," anhedonia is a common psychiatric symptom and does not specifically point to a need for urgent brain imaging in the absence of other alarming features. *Delusions of grandeur* - **Delusions of grandeur** are false beliefs that one is much greater or more powerful than they truly are, as described by the patient feeling like "the most powerful man in the world." This symptom is characteristic of **bipolar disorder (manic episodes)** or some **psychotic disorders**. - While present in this patient, grandiose delusions are part of the core symptomatology of many psychiatric conditions and, by themselves, do not typically necessitate brain imaging to rule out a tumor. *Thought broadcasting* - **Thought broadcasting** is the belief that one's thoughts are being transmitted into the minds of others, a classic **first-rank symptom of schizophrenia**. - This symptom is indicative of a severe thought disorder within the spectrum of psychotic illnesses but does not specifically raise the suspicion of an underlying brain lesion requiring neuroimaging.

Psychotic Disorders US Medical PG Question 8: A 34-year-old man presents to the behavioral health clinic for an evaluation after seeing animal-shaped clouds in the form of dogs, cats, and monkeys. The patient says that these symptoms have been present for more than 2 weeks. Past medical history is significant for simple partial seizures for which he takes valproate, but he has not had his medication adjusted in several years. His vital signs include: blood pressure of 124/76 mm Hg, heart rate of 98/min, respiratory rate of 12/min, and temperature of 37.1°C (98.8°F). On physical examination, the patient is alert and oriented to person, time, and place. Affect is not constricted or flat. Speech is of rapid rate and high volume. Pupils are equal and reactive bilaterally. The results of a urine drug screen are as follows: Alcohol positive Amphetamine negative Benzodiazepine negative Cocaine positive GHB negative Ketamine negative LSD negative Marijuana negative Opioids negative PCP negative Which of the following is the most likely diagnosis in this patient?

• A. Delusion
• B. Alcohol withdrawal
• C. Visual hallucination
• D. Cocaine intoxication
• E. Illusion (Correct Answer)

Psychotic Disorders Explanation: ***Illusion*** - The patient is seeing **animal shapes in the clouds**, which is a misinterpretation of a real external stimulus. This is the definition of an **illusion**. - Unlike hallucinations, illusions involve a distorted perception of an existing object, rather than perceiving something that is not present. *Delusion* - A **delusion** is a **fixed, false belief** that is not amenable to change in light of conflicting evidence, and it is not what is being described here. - The patient is experiencing a perceptual distortion, not a false belief system. *Alcohol withdrawal* - While the patient tests positive for alcohol, the symptoms described are **perceptual distortions** (misinterpretation of clouds), not typical signs of alcohol withdrawal which include tremors, seizures, and delirium tremens. - The timeline of "more than 2 weeks" also makes acute alcohol withdrawal less likely, as withdrawal symptoms typically peak within days. *Visual hallucination* - A **hallucination** is a perception in the absence of an external stimulus; the patient would be seeing animals when no clouds (or other visual stimuli) are present. - The patient is seeing animal shapes *in the clouds*, indicating an existing external stimulus that is being misinterpreted. *Cocaine intoxication* - While cocaine intoxication can cause psychiatric symptoms like paranoia and hallucinations, the specific description of **seeing animal shapes in clouds** (misinterpretation of a real stimulus) points more directly to an illusion rather than a primary effect of cocaine use. - The patient's presentation does not include other common symptoms of acute cocaine intoxication like severe agitation, dilated pupils, or hyperthermia beyond a rapid heart rate.

Psychotic Disorders US Medical PG Question 9: A 21-year-old man presents to an outpatient psychiatrist with chief complaints of fatigue and “hearing voices.” He describes multiple voices which sometimes call his name or say nonsensical things to him before he falls asleep at night. He occasionally awakes to see “strange people” in his room, which frighten him but then disappear. The patient is particularly worried by this because his uncle developed schizophrenia when he was in his 20s. The patient also thinks he had a seizure a few days ago, saying he suddenly fell to the ground without warning, though he remembers the episode and denied any abnormal movements during it. He is in his 3rd year of college and used to be a top student, but has been getting C and D grades over the last year, as he has had trouble concentrating and fallen asleep during exams numerous times. He denies changes in mood and has continued to sleep 8 hours per night and eat 3 meals per day recently. Which of the following medications will be most beneficial for this patient?

• A. Haloperidol
• B. Valproic acid
• C. Risperidone
• D. Modafinil (Correct Answer)
• E. Levetiracetam

Psychotic Disorders Explanation: ***Modafinil*** - This patient presents with **narcolepsy**, characterized by the **classic tetrad**: excessive daytime sleepiness (falling asleep during exams), **cataplexy** (sudden fall without loss of consciousness or abnormal movements), **hypnagogic hallucinations** (hearing voices before sleep), and **hypnopompic hallucinations** (seeing people upon awakening). - The hallucinations are **not true psychotic symptoms** but rather dream-like phenomena occurring at sleep-wake transitions, which are common in narcolepsy. - **Modafinil** is a first-line **wakefulness-promoting agent** that treats the excessive daytime sleepiness and improves alertness, addressing the primary pathology. - The patient's family history of schizophrenia is a red herring; his symptoms are explained by narcolepsy, not a primary psychotic disorder. *Risperidone* - Risperidone is an **atypical antipsychotic** used for schizophrenia and other psychotic disorders. - This patient does **not have a primary psychotic disorder**—the hallucinations are hypnagogic/hypnopompic phenomena associated with narcolepsy, not true psychotic hallucinations. - Using an antipsychotic would be inappropriate and could **worsen daytime sleepiness** due to sedating effects, exacerbating the patient's core problem. *Haloperidol* - Haloperidol is a **first-generation antipsychotic** with significant risk of **extrapyramidal side effects**. - Like risperidone, it would be inappropriate here as the patient does not have a psychotic disorder, and it would worsen sedation and daytime sleepiness. *Valproic acid* - Valproic acid is a **mood stabilizer and anticonvulsant** used for bipolar disorder and seizure disorders. - The described "seizure" event is actually **cataplexy** (preserved consciousness, no abnormal movements), not a true seizure, so an anticonvulsant is not indicated. - It would not address the narcolepsy symptoms and can cause sedation. *Levetiracetam* - Levetiracetam is an **anticonvulsant** medication. - The patient's description (remembering the episode, no abnormal movements) is inconsistent with a seizure and consistent with **cataplexy**, which is treated by addressing the underlying narcolepsy, not with anticonvulsants.

Psychotic Disorders US Medical PG Question 10: A 30-year-old man comes to the emergency department because of fever and productive cough for the past 4 days. During this period, he has had shortness of breath and chest pain that is worse on inspiration. He also reports fatigue and nausea. He has refractory schizophrenia and recurrent asthma attacks. He used to attend college but was expelled after threatening to harm one of his professors 2 months ago. His temperature is 38.5°C (101.3°F), pulse is 90/min, respirations are 20/min, and blood pressure is 120/80 mm Hg. Crackles and bronchial breath sounds are heard on auscultation of the left lung. Laboratory studies show: Hemoglobin 13.5 g/dL Leukocyte count 1,100/mm3 Segmented neutrophils 5% Eosinophils 0% Lymphocytes 93% Monocytes 2% Platelet count 260,000/mm3 Which of the following medications is this patient most likely taking?

• A. Chlorpromazine
• B. Risperidone
• C. Haloperidol
• D. Olanzapine
• E. Clozapine (Correct Answer)

Psychotic Disorders Explanation: ***Clozapine*** - The patient exhibits severe **agranulocytosis** (WBC count 1,100/mm³ with 5% neutrophils, indicating an absolute neutrophil count of 55/mm³), a life-threatening side effect uniquely associated with **clozapine** among antipsychotics. - Given his history of **refractory schizophrenia** (implying resistance to other antipsychotics), clozapine is the most likely antipsychotic he would be prescribed. *Chlorpromazine* - This first-generation antipsychotic can cause adverse effects like **sedation, orthostatic hypotension, and anticholinergic symptoms**, but severe agranulocytosis is rare. - While it can cause leukopenia, the profound agranulocytosis seen in the patient is not characteristic of chlorpromazine. *Risperidone* - Atypical antipsychotic known for side effects such as **hyperprolactinemia, weight gain, and metabolic syndrome**. - Though it can cause neutropenia or leukopenia, it rarely causes the severe agranulocytosis observed here. *Haloperidol* - A high-potency first-generation antipsychotic primarily associated with **extrapyramidal symptoms (EPS)** and **neuroleptic malignant syndrome (NMS)**. - It does not typically cause the severe bone marrow suppression, specifically agranulocytosis, observed in this patient. *Olanzapine* - This atypical antipsychotic is associated with significant **weight gain, sedation, and metabolic syndrome**. - While it can cause some hematologic abnormalities, it is not known to cause severe agranulocytosis to the same extent as clozapine.

Psychotic Disorders Flashcard 1 of 10

Question: Cluster A personality disorders lack _____, which is a distinguishing feature from schizophrenia

Answer: psychosis

Psychotic Disorders Flashcard 2 of 10

Question: The nigrostriatal pathway is significantly affected by movement disorders and _____ drugs

Answer: antipsychotic

Psychotic Disorders Flashcard 3 of 10

Question: A _____ disorder is an inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning

Answer: personality

Psychotic Disorders Flashcard 4 of 10

Question: Which psychiatric disorder, delirium or dementia, is characterized by disorganized thinking, visual hallucinations, disturbances in sleep wake cycle, cognitive dysfunction, and agitation? _____

Answer: Delirium

Psychotic Disorders Flashcard 5 of 10

Question: What is the treatment for borderline personality disorder? _____

Answer: Dialectical behavioral therapy

Psychotic Disorders Flashcard 6 of 10

Question: What feature of psychosis is characterized by speech that is incoherent ("word salad"), tangential, or derailed? _____

Answer: Disorganized thought

Psychotic Disorders Flashcard 7 of 10

Question: What is the treatment for postpartum psychosis? _____

Answer: Hospitalization and antipsychotics

Psychotic Disorders Flashcard 8 of 10

Question: Broca's aphasia

Answer: damage to inferior frontal gyrus of dominant frontal lobe

Extra Information: nonfluent speech, intact comprehensionmnemonic: Broca's Broken Boca

Psychotic Disorders Flashcard 9 of 10

Question: Wernicke's aphasia

Answer:

Extra Information: fluent but nonsensical speech, impaired comprehensionmnemonic: Wernicke's Wordy Widdershins (widdershins is nonsense in this context)superior temporal gyrus of dominant temporal lobe

Psychotic Disorders Flashcard 10 of 10

Question: global aphasia

Answer: damage to both Broca's and Wernicke's areas (dominant frontal and temporal lobes)

Extra Information: nonfluent speech, impaired comprehension