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Zorluk: ZorSchizophrenia and Psychotic Disorders

A 23-year-old woman comes to the outpatient psychiatric clinic for a follow-up appointment. Five months ago, she experienced the sudden onset of auditory hallucinations and persecutory delusions, believing that her university professors were conspiring to harm her. These symptoms began abruptly three days after she was involved in a severe motor vehicle collision. She was hospitalized and started on oral aripiprazole. Her psychotic symptoms completely resolved 3 weeks after they initially began. She was subsequently discharged and has been taking aripiprazole daily. She has had no recurrence of symptoms for the past 4 months, and her academic and social functioning have returned entirely to their premorbid baseline. She is bothered by mild weight gain and asks how much longer she must continue taking the medication. What is the most appropriate next step in the management of this patient's pharmacotherapy?

  1. Taper and discontinue the medication over the next few weeksCevap
  2. B
    Continue the medication for an additional 6 months
  3. C
    Continue the medication for an additional 1 to 2 years
  4. D
    Continue the medication indefinitely
  5. E
    Cross-taper to an antipsychotic with a lower metabolic risk profile

Cevap

Taper and discontinue the medication over the next few weeks
The most appropriate next step is to taper and discontinue the antipsychotic medication. This patient's clinical presentation—sudden onset of hallucinations and delusions following a stressor, with complete symptom resolution within 1 month and a full return to baseline functioning—is diagnostic of brief psychotic disorder. According to standard psychiatric guidelines, antipsychotic medication for brief psychotic disorder should be continued for 1 to 3 months after symptom remission to ensure clinical stability. Because this patient has been entirely asymptomatic for 4 months, she has safely completed the maintenance phase. The medication should now be gradually tapered to minimize withdrawal effects and the risk of relapse, which will also resolve her medication-induced weight gain.

Adım Adım Çözüm

1
Determine the total duration of the patient's active psychotic symptoms and overall illness course.
The psychotic symptoms began abruptly and resolved completely within 3 weeks.
Symptom duration is the primary differentiator between various primary psychotic disorders.
2
Establish the most likely diagnosis based on symptom duration and functional recovery.
The diagnosis is brief psychotic disorder with a marked stressor.
Brief psychotic disorder is characterized by psychotic symptoms lasting between 1 day and 1 month, followed by a full return to the premorbid level of functioning.
3
Identify the standard pharmacological maintenance guidelines for the diagnosed condition.
Antipsychotic therapy should be tapered after 1 to 3 months of symptom remission.
Because the patient has been asymptomatic for 4 months, she has completed the recommended maintenance phase, and the medication should now be discontinued.

Anahtar Kavram

Pharmacological management and maintenance timeline of brief psychotic disorder
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Konular

Schizophrenia and Psychotic Disorders

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