Rosh Psychiatry Board Practice Exam

What is the appropriate action for a patient on risperidone experiencing involuntary facial movements and no previous history of hallucinations?

1. Decrease the dose of risperidone and add clonazepam

2. Discontinue risperidone and refer for psychotherapy

3. Discontinue risperidone and replace with clozapine

4. Discontinue risperidone and replace with fluoxetine

The correct answer is: Discontinue risperidone and refer for psychotherapy

The appropriate action for a patient on risperidone exhibiting involuntary facial movements, particularly when there is no prior history of hallucinations, likely indicates the development of tardive dyskinesia or acute dystonia, which are potential side effects associated with antipsychotic medications. Discontinuing risperidone is crucial in such cases to prevent further exacerbation of involuntary movements and avoid potential long-term consequences associated with these conditions. Referring for psychotherapy could also be beneficial for addressing the patient's psychological distress during this period, though the primary focus should be on managing the side effects of the antipsychotic medication. Other medications, such as clonazepam or a switch to medications like clozapine or fluoxetine, might not appropriately address the acute symptoms of tardive dyskinesia and could introduce additional risks or complications. Overall, the decision to discontinue risperidone addresses the immediate concern of involuntary facial movements while prioritizing the patient's well-being by exploring therapeutic alternatives in a more stable context.