A 53-Year-Old Man Has Been Prescribed Fluphenazine for Many Years

question 271

Multiple Choice

A 53-year-old man has been prescribed fluphenazine for many years for schizophrenia.  He lives in a group home and is accompanied by his caseworker.  His psychotic symptoms have been stable, but he has developed a tremor in his hands and his caseworker has noticed that he walks slower.  His medical history is significant for obesity, hypercholesterolemia, and hypertension, for which he takes lisinopril and simvastatin.  He has been trying to exercise and eat healthy foods and has managed to lose 5 kg (11 lb) since his last visit 3 months ago.  He is concerned about his hands shaking and would like to lose more weight.  He wonders if he might do better on a different medication.
Vital signs are normal.  BMI is 37 kg/m².  Mental status examination is significant for psychomotor retardation, slow speech, and lack of facial expressions.  A resting tremor of the hands is noted.
ECG shows normal sinus rhythm without abnormalities.
The physician discusses the risks and benefits of switching to a different antipsychotic medication.  Considering the patient's history, which of the following medications would be most appropriate?

• A)Aripiprazole
• B)Clozapine
• C)Haloperidol
• D)Olanzapine
• E)Risperidone

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