A 54-Year-Old Man Comes to the Emergency Department for Evaluation

question 164

Multiple Choice

A 54-year-old man comes to the emergency department for evaluation of fever and sore throat, and also due to trouble sleeping, poor energy, and hearing voices for the past 3 days.  He has a history of hypertension, hypercholesterolemia, and schizoaffective disorder.  The patient has been hospitalized several times in the past for auditory hallucinations ordering him to kill himself and has attempted suicide twice in the past 3 years.  His symptoms have been stable on his current regimen of lithium and clozapine for the past 8 months.  The patient's other medications include metoprolol and atorvastatin.  He has started to feel depressed again and is concerned that the voices may get worse.  He has no current suicidal ideation.
Temperature is 39.4 C (103 F) , blood pressure is 110/70 mm Hg, pulse is 108/min, and respirations are 16/min.  Examination is significant for pharyngeal erythema.
Laboratory results are as follows:
In addition to antibiotic therapy, which of the following is the most appropriate next step in management of this patient?

• A)Add fluoxetine
• B)Add haloperidol
• C)Discontinue clozapine
• D)Increase clozapine
• E)Increase lithium

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Definitions:

Key Logger

A tool that records every keystroke made by a computer user, often used for surveillance or malicious purposes.

Online Affair

An emotional or sexual relationship initiated and maintained primarily through internet communication, often considered infidelity.

Deny Guilt

The act of a defendant in a legal case asserting their innocence in response to accusations or charges against them.

Cyberporn Surfers

Individuals who frequently browse or search for pornography on the internet.