Rosh Psychiatry Board Practice Exam

Co-administering diphenhydramine is an effective strategy for mitigating extrapyramidal symptoms (EPS) in a patient receiving haloperidol, which is a first-generation antipsychotic known for its potential to cause these side effects. Diphenhydramine, an antihistamine with anticholinergic properties, can help counteract the acute movement disorders that may arise from haloperidol use, such as acute dystonia or Parkinsonism.

While other medications listed may have their uses in the management of agitation or as part of a treatment regimen for psychiatric conditions, diphenhydramine specifically has a well-established role in addressing EPS due to its ability to block the effects of dopamine in the nigrostriatal pathway, thus reducing the likelihood of movement abnormalities. This makes it a common choice in clinical practice when acute agitation is treated alongside a first-generation antipsychotic.

Chlorpromazine, although also an antipsychotic, could exacerbate EPS rather than mitigate them. Lorazepam is useful for sedation but does not specifically address the underlying mechanisms of EPS. Olanzapine, while effective for agitation, is an atypical antipsychotic that is not typically used for EPS management associated with haloperidol