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.) A 23-year-old man is brought to the physician by his mother because he has heard
a voice over the past month telling him to hurt himself. His mother says that her
son has no friends and is a lifelong loner; since graduating from high school, he
has been unable to hold a job. He admits to smoking marijuana occasionally and
drinking six beers weekly. Examination shows a poorly groomed man with poor
eye contact. He has a flat affect and limited facial expression. He says he has no
intention of harming himself or others. Which of the following is the most
appropriate next step in management?

A) Schedule a follow-up visit in 4 weeks

B) Prescribe oral risperidone and schedule a follow-up visit in 2 weeks

C) Admit him to the partial hospital program and prescribe oral lithium carbonate

D) Admit him to the psychiatric unit for detoxification

E) Admit him to the psychiatric unit and prescribe oral imipramine


B) Prescribe oral risperidone and schedule a follow-up visit in 2 weeks


It's not A for sure,

As " he has heard a voice over the past month telling him to hurt himself" i guess he should be admitted to the hospital.. But I'm not sure of Lithium nor imipramine.. they may not help in this case..

I'll go with B , It's more suitable.. even though it doesnt say that he should be hospitalized. !!


i think that it's B

however, i really want to send this guy to the hospital. i agree that the in-pt. options sound incorrect. i guess what it comes down to is that he's not actively thinking of hurting himself, even tho the voice is telling him to (unfortunately, many schizophrenics live at a base line of constantly hearing voices - it's about whether they act on those thoughts or not).




A) He has overt psychotic features, needs treatment
C) no signs of mania
D) detox from what?
E) not depressed in need of TCA

This doesn't fit into SCH - history of only one month, so it is schizophreniform disorder. He still needs antipsychotics.


heh, another bitch question.
here's my notes:

Brief psychotic =skizo for a day…1d-1m, not if alcohol or drugs.
Schizophreniform 1m-6m --> antipsychotics

so is this brief/schizoform/personality+alcoholic problems ?


Schizophreniform Disorder
Psychotic symptoms (hallucinations, delusions, disorg speech, negative sympt) >1m and <6m. Pts can return to baseline with Tx. Depressive suicide is a risk factor. 
1. Evaluate and hospitalize if needed
2. Antypsychotic meds for 3-6m, individual psychotherapy 

Ans: B
because he has no intention to harm himself

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