A 25-Year-Old Man Is Brought to the Hospital for Admission

question 125

Multiple Choice

A 25-year-old man is brought to the hospital for admission by his mother.  She says, "I feel badly but I couldn't manage him at home anymore.  He locks himself in his bedroom and refuses to shower.  Yesterday, he started screaming as if he were arguing with someone but no one was there."  The patient is very guarded and makes no eye contact.  He says, "The world is coming to an end and I am waiting to receive a message through the Internet indicating the exact date."  He also claims that family members want to kill him because they believe the world could be saved if he were dead.  The patient describes his mood as "anxious and fearful" and does not feel depressed.  He has no suicidal or homicidal ideation.  The patient was first hospitalized at age 19 and treated with risperidone and clonazepam.  In the past 2 years, he was hospitalized 3 times for acute psychosis and treated with olanzapine.  In each case he improved while in the hospital but then stopped taking the medication shortly after discharge.  The patient has a history of childhood asthma and alcohol abuse.  He has no known drug allergies.  His sister and father have a history of anxiety disorder.  Physical examination shows no abnormalities.  The patient is 175 cm (5 ft 9 in) tall and weighs 120 kg (265 lb) .  His BMI is 39 kg/m².  Urine toxicology screen is negative.  His mother worries that his illness is getting worse and asks if anything else can be done.  Which of the following is the most appropriate response to the mother's concerns?

• A)"I recommend adding clonazepam to an antipsychotic to help decrease his anxiety and agitation."
• B)"Once he is stabilized, I would recommend treatment with a long-acting injectable antipsychotic."
• C)"Unfortunately, his illness appears to be worsening; I suggest we reevaluate the primary diagnosis with additional history and testing."
• D)"Your son is a good candidate for a trial of clozapine, a uniquely effective antipsychotic."
• E)"Your son will likely respond well to restarting olanzapine."

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Definitions:

Peristalsis

Rhythmic waves of muscular contraction and relaxation in the walls of hollow tubular organs, such as the ureter or parts of the digestive tract, that serve to move the contents through the tube.

Digestive Tract

The series of hollow organs joined in a long, twisting tube from the mouth to the anus, through which food is digested and nutrients absorbed.

Chief Cells

Cells located in the stomach that secrete pepsinogen, an enzyme precursor that plays a key role in digestion.

Pepsinogen

The precursor of pepsin; secreted by chief cells in the gastric glands of the stomach.