A 19-year-old woman, accompanied by her parents, presents after a one-week history of abnormal behavior, delusions, and unusual aggression. She denies fever, seizures or illicit drug use. Family history is negative for psychiatric illnesses. She was started on risperidone and sent home with her parents. Three days later, she is brought to the emergency department with fever and confusion. She is not verbally responsive. At the hospital, her temperature is 39.8°C (103.6°F), the blood pressure is 100/60 mm Hg, the pulse rate is 102/min, and the respiratory rate is 16/min. She is extremely diaphoretic and appears stiff. She has spontaneous eye-opening but she is not verbally responsive and she is not following commands. Laboratory studies show: Sodium 142 mmol/L Potassium 5.0 mmol/L Creatinine 1.8 mg/dl Calcium 10.4 mg/dl Creatine kinase 9800 U/L White blood cells 14,500/mm3 Hemoglobin 12.9 g/dl Platelets 175,000/mm3 Urinalysis shows protein 1+, hemoglobin 3+ with occasional leukocytes and no red blood casts. What is the best first step in the management of this condition?
AParacetamol
BDantrolene
CIntravenous hydration
DSwitch risperidone to clozapine
EStop risperidone
A study is conducted to investigate the relationship between the development of type 2 diabetes mellitus and the use of atypical antipsychotic medications in patients with schizophrenia. 300 patients who received the atypical antipsychotic clozapine and 300 patients who received the typical antipsychotic haloperidol in long-acting injectable form were followed for 2 years. At the end of the observation period, the incidence of type 2 diabetes mellitus was compared between the two groups. Receipt of clozapine was found to be associated with an increased risk of diabetes mellitus relative to haloperidol (RR = 1.43, 95% p<0.01). Developed type 2 diabetes mellitus Did not develop type 2 diabetes mellitus Clozapine 30 270 Haloperidol 21 279 Based on these results, what proportion of patients receiving clozapine would not have been diagnosed with type 2 diabetes mellitus if they had been taking a typical antipsychotic?
A1.48
B0.3
C0.43
D0.03
E33.3
A 35-year-old woman comes to the physician accompanied by her husband after he started noticing strange behavior. He first noticed her talking to herself 8 months ago. For the past 6 months, she has refused to eat any packaged foods out of fear that the government is trying to poison her. She has no significant past medical history. She smoked marijuana in college but has not smoked any since. She appears restless. Mental status examination shows a flat affect. Her speech is clear, but her thought process is disorganized with many loose associations. The patient is diagnosed with schizophrenia and started on olanzapine. This patient is most likely to experience which of the following adverse effects?
ADyslipidemia
BDiabetes insipidus
CAgranulocytosis
DMyoglobinuria
ESeizures
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