pscy q help - medplus254

[ArchivalUser]

) 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

[ArchivalUser]

i think the answer is B. Pt is hearing voices, has flat effect, poorly groomed manner, and he has no intention of hurting of himself, so we can rule out depression. Lithium carbonate is usually prescribed to people with bipolar disorder, I dont think this patient has bipolar.

[ArchivalUser]

but can you trust pts intention of not hurting himself /others ...why not admit him?
this my confusion

[ArchivalUser]

best option is to admit since his thinking to commit suicide THEN give lithium as for the mood.since mood disorders are characterized by periods of normal or near-normal affect and function in between more severe mood “episodes.”so option c

[ArchivalUser]

Whenever you're answering "next step in management" questions, your absolute #1 priority is to answer the question: what is my working diagnosis? If there isn't enough information for that, then answer this question: what am I most worried about? I see students I tutor constantly skipping this step and it invariably leads them to wrong answers.

This patient is presenting with symptoms of schizophrenia. He has the positive symptom of auditory hallucinations, and multiple negative symptoms, so this is our working diagnosis.

The next question we must answer in any psych patient is this: is this person a danger to themselves or to others. In this case, the patient says he has no intention of harming himself or others, so he does not meet criteria for inpatient involuntary admission.

We need to start treatment with an antipsychotic and schedule close follow up, so in this case BB is the correct answer. Explanations for the other wrongs answers are as follows:

a) this patient needs treatment for his schizophrenia
b) Correct
c) This would be the correct treatment for bipolar or other mood disorder, but that is not what this patient has. He has a psychotic disorder, not a mood disorder, so lithium is not indicated at this point.
d) there is no evidence of acute intoxication; 6 beers per week is not even heaving drinking in a male of his age
e) he does not meet criteria for inpatient admission; he has no indication for starting a tricyclic antidepressant