A 51-Year-Old Man with a Long-Standing History of Schizophrenia Is

A 51-year-old man with a long-standing history of schizophrenia is evaluated for agitation and oppositional behavior at a group home.  He was admitted to the group home yesterday after his mother, with whom he previously lived, moved to an assisted care facility.  A staff member reports the patient was cooperative and calm when he arrived and did not talk much, which seems to be his baseline.  He did not sleep well last night, and today he has been pacing around and yelling at other residents and staff.  The patient has no other medical conditions.  Medications include clozapine.  He does not use tobacco or illicit drugs but does use alcohol.  Temperature is 36.7 C (98.1 F) , blood pressure is 152/94 mm Hg, and pulse is 114/min.  On physical examination, the patient appears anxious and diaphoretic and is fidgeting in his seat.  Marked hand tremors are present.  He is alert and oriented to person, place, and time.  Which of the following is the best next step in the management of this patient?

A) Add benztropine
B) Begin selective serotonin reuptake inhibitor
C) Discontinue clozapine
D) Prescribe benzodiazepine
E) Recommend brief psychotherapy

Correct Answer:

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