A 51-Year-Old Man with a Long-Standing History of Schizophrenia Is

question 34

Multiple Choice

A 51-year-old man with a long-standing history of schizophrenia is evaluated for agitation and oppositional behavior at a group home.  He was admitted to the group home yesterday after his mother, with whom he previously lived, moved to an assisted care facility.  A staff member reports the patient was cooperative and calm when he arrived and did not talk much, which seems to be his baseline.  He did not sleep well last night, and today he has been pacing around and yelling at other residents and staff.  The patient has no other medical conditions.  Medications include clozapine.  He does not use tobacco or illicit drugs but does use alcohol.  Temperature is 36.7 C (98.1 F) , blood pressure is 152/94 mm Hg, and pulse is 114/min.  On physical examination, the patient appears anxious and diaphoretic and is fidgeting in his seat.  Marked hand tremors are present.  He is alert and oriented to person, place, and time.  Which of the following is the best next step in the management of this patient?

• A)Add benztropine
• B)Begin selective serotonin reuptake inhibitor
• C)Discontinue clozapine
• D)Prescribe benzodiazepine
• E)Recommend brief psychotherapy

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Definitions:

Coaction Effect

The phenomenon that individuals perform tasks better or work harder in the presence of others doing the same task.

Audience Effect

The impact that the presence of spectators has on an individual's performance, often resulting in enhancements or deteriorations.

Energy Motivation

The drive to engage in activities due to an intrinsic desire to expend energy and seek stimulation.

Observation Motivation

Observation motivation is the drive or inclination to learn or acquire new behaviors, skills, or information by observing others rather than through direct experience.