Question
29-year-old man is brought to the emergency department from a homeless shelter because of bizarre behavior. He avoids contact with others and has complained to the supervising staff that he thinks people are reading his mind. Three days ago, he unplugged every electrical appliance on his floor of the shelter because he believed they were being used to transmit messages about him to others. The patient has schizophrenia and has been prescribed risperidone but has been unable to comply with his medications because of his unstable living situation. He is disheveled and malodorous. His thought process is disorganized and he does not make eye contact. Which of the following is the most appropriate long-term pharmacotherapy?
| A. |
IM Benztropine
|
| B. |
Oral diazepam
|
| C. |
IM risperidone
|
| D. |
IM diphenhydramine
|
Show Answer
|
Correct Answer � C
Explanation
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|
IM risperidone
Intramuscular benztropine
Benztropine is used in the management of extrapyramidal syndromes associated with antipsychotic use (such as dystonia and akathisia), and intramuscular (IM) administration is preferred in the acute setting. However, this patient has none of these manifestations.
Oral diazepam
Diazepam, a benzodiazepine, can be used in the management of acute extrapyramidal syndromes associated with antipsychotic use (such as dystonia and akathisia). However, this patient has none of these manifestations.
Intramuscular risperidone
Long-acting injectable antipsychotics, such as intramuscular (IM) risperidone, are the preferred pharmacologic strategy for treating schizophrenic patients with relapses due to medication noncompliance. IM risperidone is generally administered every 2 weeks but continues to be absorbed 4–6 weeks after injection.
Intramuscular diphenhydramine
Diphenhydramine, an antihistamine, can be used in the management of acute extrapyramidal syndromes associated with antipsychotic use (such as acute dystonia and akathisia). However, this patient has none of these manifestations.
