JH
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This is from NBME 1 .
A 47-year-old man is admitted to the hospital after threatening to harm a radio announcer he believed was broadcasting his thoughts. Over the past 20 years. he has had multiple psychiatric hospitalizations for threatening people who he believed were plotting against him, trying to control his mind, or causing him to hear voices by implanting devices in his head. Past symptoms improved with neuroleptic therapy; after discharge. he discontinued the medication and his symptoms worsened. Which of the following is the most appropriate pharmacotherapy to decrease this patient's risk for future hospitalization?
A) Clozapine
B) Fluphenazine hydrochloride
C) Haloperidol decanoate
D) Risperidone
E) Trifluoperazine hydrochloride
Edited by JH on 10/27/06 - 11:16 PM
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| saadtazjam
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D??
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| JH
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I don't know.
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| tolito
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i also chose C. cos it can be given as a depot and so it will take a while before he will have another relapse.
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| study_ing
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hmm.. how do we choose between B and C?
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| study_ing
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fluphenazine hydrochloride is oral, not parennteral ( as i had thought). haloperidol decanoate can be given Im as a depot. hence its the answer.
Edited by study_ing on 10/09/06 - 02:03 PM
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| brokenhearted
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nut option D is Risperidone....so now I'm confused which one is it...is it Risperidon or haloperidol?
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| robin082006
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I would go with Haloperidol as this is positive symptom of schizophrenia.
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| study_ing
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oops i meant C. the decanote. i l ledit it to save future confusion
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| brokenhearted
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so the final answer is c)Haloperidol?
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| HighHopes
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why not d?
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| JH
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tolito wrote:
i also chose C. cos it can be given as a depot and so it will take a while before he will have another relapse.
Here is some useful information from UW:
Treatment noncompliance in schizophrenic patients is common and results from several factors. Patients who live by themselves, who have poor social support systems, who are elderly, or who have developed side effects with the use of neuroleptics are all more likely to be noncompliant with their medications. This noncompliance leads to symptom exacerbation, relapse, and recurrent hospitalization. It is therefore recommended that schizophrenic patients with a history of noncompliance be given long-acting injectable antipsychotics such as fluphenazine or haloperidol. When administered in an outpatient setting at regularly scheduled intervals (usually twice per month), high doses of injectable antipsychotics allow for better symptom control and circumvent the issue of poor medication adherence.
So I still don't know the answer: B or C.
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| shemesh
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The right answer is Haldol decanoate(C). This is supposed to be a trick question. In schizophrenics in whom compliance is a major problem, depot medications are recommended. To date there are very few depot antipsychotics: Fluphenazine decanoate( not HCl), Haldol decanoate and risperdone consta. The first two are esthers of long chain fatty acids which form an oily solution at the injection site which is absorbed very slowly into the blood stream. Note however, choice D is not a fatty formulation.
Risperidone employs a different technology and, anyway, is not provided in the choices as the depot form.
SO THE ANSWER IS C.
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| kashdoc21
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ANS --B
it has long half life
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| fongch
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Risperidone also has depot form (at least in UK, not sure here).
http://www.rcpsych.ac.uk/mentalhealthinformation/...
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| fongch
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Found injectable risperidone is also available in US - RISPERDAL CONSTA
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| NE
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Are 2 antipsichotics in depot form: haloperidol decanoate and flufenazine decanoate. Flufenazine hydrochloride is not a depot form.
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| PGI2alpha
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the answer shd b haldol decanoate..the only correct depot preparation tht is given in the choices...
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| hanwin
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This is C.
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| ssrpk
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agree with C and good explanation by shemesh
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| cirus
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first of all in the Psych lectures, Both Haloperidol & Fluphenazine are depot for uncompliant pts..BUT Haloperidol is first line so if both, choose Haloperidol
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| deardoc007
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Ans is c. flufenazine is given twice a month and haloperidol once a month. so if compliance is issue haloperidol is ans.
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| gr8doc
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Haloperidol deconate is the answer.
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