Mngt Schizo - Cases

Question 1

VL is a Schizo patient who presented with motor complications of antipsychotic tx. The doctor ordered to administer IM-antiM to the patient.

Which of the following motor complications could have manifested in VL?

A. Dystonia
B. Akathisia
C. Pseudo-Parkinsonism
D. Tardive Dyskinesia

Answer 1

Ans: A

• B: Anti-M useless. Use low dose clonazepam PRN instead
• C: Anti-M PRN, not specifically IM
• D: Anti-M WORSENS. Use Valbenazine 40-80mg/d, or Clonazepam PRN

Question 2

MP is a Schizo patient who has gained 5kg of weight. He has been on Olanzapine for a one month now and gained a lot of weight due to binge eating. He has not been taking any actions so fr

Which of the following is the BEST course of action for MP?

A. Switch to Clozapine
B. Switch to Lurasidone
C. Add PO Lorazepam
D. Counsel MP to have a healthy diet and exercise regularly
E. Add Quetiapine

Answer 2

Ans: D

• B is possible. but according to tx principle of Schizo, always try to manage SE before switching, unless life-threatening or intolerable

Question 3

KT is a F new onset Schizo patient who is prescribed Aripiprazole. One week later, her husband called the clinic to report that the medication does not work on KT, and KT is still talking to his “imaginary alien friends”

Which of the following is the MOST appropriate action for KT?

A. Switch to Olanzapine
B. Switch to Clozpine
C. Add PO Lorazepam
D. Taper the dose of Aripiprazole
E. Titrate the dose of Aripiprazole upwards

Answer 3

Ans: E
- Schizo tx principle: Adequate trial = 2-6 weeks of OPTIMAL dose
- Since it only has been one week, patient is not on full dose of aripiprazole yet
- Also, effects of neuroleptics:
1wk - Less agitatio and aggression
2-4 wk - less hallucinations
6-12wk - less delirum and less -ve effects

Takes long time