Rosh Psychiatry Board Practice Exam

What is the most appropriate treatment for a patient displaying altered mental status after abruptly quitting alcohol?

1. Chlorpromazine

2. Lithium

3. Lorazepam

4. Olanzapine

The correct answer is: Lorazepam

In the case of a patient presenting with altered mental status after abruptly quitting alcohol, the most appropriate treatment is lorazepam. This conclusion is primarily based on the understanding of alcohol withdrawal syndrome, which can lead to symptoms such as agitation, tremors, anxiety, and, in more severe cases, delirium tremens. Lorazepam, being a benzodiazepine, is effective in managing withdrawal symptoms due to its ability to enhance the inhibitory effects of GABA (gamma-aminobutyric acid) in the central nervous system. Benzodiazepines are the first-line treatment for alcohol withdrawal because they can help prevent the progression of symptoms and reduce the risk of seizures, which are a potential complication. Lorazepam, in particular, is often favored in this context due to its pharmacokinetic properties, as it is a short-acting agent with fewer active metabolites, making it suitable for patients with liver impairment common in chronic alcohol users. The other medications listed serve different purposes and are not typically indicated in the acute management of alcohol withdrawal. Chlorpromazine, an antipsychotic, can have sedative effects but is not appropriate for treating seizure risk or managing withdrawal symptoms specifically. Lithium is a mood stabilizer used primarily for bipolar