A 47-Year-Old Man with a Long History of Schizoaffective Disorder

A 47-year-old man with a long history of schizoaffective disorder comes to the clinic with his wife.  After a difficult course requiring several psychiatric hospitalizations and poor response to multiple antipsychotics and mood stabilizers, the patient's condition has been relatively stable for the past 3 years with high doses of lithium and risperidone.  Lowering his dose of risperidone resulted in worsening psychotic symptoms, so the dose was subsequently increased.  The patient's wife states that his psychiatric symptoms have improved with the current medications, but they are both concerned about new abnormal movements he has begun to make.  He has no other medical conditions and takes no other medications.  The patient does not use tobacco, alcohol, or illicit drugs.  Blood pressure is 120/70 mm Hg, pulse is 72/min, and respirations are 12/min.  Lithium level is 1.2 mEq/L (range: 0.8-1.2) .  During examination, the patient repeatedly taps his foot, protrudes his tongue, and smacks his lips.  The rest of the examination shows no abnormalities.  The patient is treated with sequential trials of valbenazine and deutetrabenazine but shows no significant improvement in abnormal movements at follow-up.  Which of the following is the most appropriate next step in management of this patient?

A) Add benztropine
B) Add diphenhydramine
C) Add propranolol
D) Decrease lithium
E) Switch from risperidone to clozapine

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free