A 46-Year-Old Man Is Hospitalized Due to Suicidal Ideation and Hearing

A 46-year-old man is hospitalized due to suicidal ideation and hearing voices.  The patient has become increasingly depressed over the past month and has been unable to work.  Last week he told his wife that he was "tormented by voices" and that "death would be a relief."  She brought him to the hospital after she found him staring at a blank screen on the television and not responding to her questions.  The patient was prescribed risperidone, lithium, and escitalopram by his psychiatrist, but his wife is unsure if he takes them regularly.  He has a history of bipolar disorder since age 18 with multiple hospitalizations for both manic and depressive episodes.  His other medical problems are hypercholesterolemia and seasonal allergies.  Temperature is 37 C (98.6 F) , blood pressure is 125/80 mm Hg, pulse is 68/min, and respirations are 12/min.  Routine laboratory results are within normal limits, lithium level is within therapeutic range, and a toxicology screen is negative.  During the evaluation, the patient stares blankly and is mute and motionless.  He resists all instructions to move.  When the physician lifts the patient's arm, it remains in the exact same position after she lets go.  Which of the following is the most appropriate next step in management?

A) Benztropine
B) Clozapine
C) Cyproheptadine
D) Dantrolene
E) Increase risperidone
F) Lorazepam

Correct Answer:

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