A 53-Year-Old Man Is Seen for a Routine Health Examination

question 202

Multiple Choice

A 53-year-old man is seen for a routine health examination.  He has a 30-year history of schizophrenia and was recently diagnosed with type 2 diabetes mellitus.  The patient's other medical conditions include hypercholesterolemia and seborrheic dermatitis.  Medications include metformin, lovastatin, and haloperidol.  The patient's schizophrenia had been controlled for many years on olanzapine until he was hospitalized 6 months ago for an acute psychotic episode that occurred when he was forced to move into a group home following the death of his father.  Since discharge, his psychotic symptoms have been well controlled on a stable dose of haloperidol.
On examination, the patient is cooperative but makes little eye contact.  He appears extremely anxious and restless.  He shifts frequently in his chair and crosses and uncrosses his legs continually.  Vital signs are within normal limits.  The remainder of the physical examination, apart from moderate obesity, is unremarkable.  Laboratory studies, including comprehensive metabolic panel, complete blood count, and TSH, are within normal limits.  Hemoglobin A1c is 7%.
Which of the following is the most likely explanation for this patient's symptoms?

• A)Acute dystonic reaction
• B)Adjustment disorder with anxiety
• C)Akathisia
• D)Psychotic agitation
• E)Tardive dyskinesia