Rosh Psychiatry Board Practice Exam

When a patient presents with symptoms consistent with psychosis after recent substance use, what initial approach may be necessary?

1. Hospitalization for psychiatric evaluation

2. Immediate initiation of antipsychotic medication

3. Provision of supportive care and monitoring

4. Referral to specialized substance abuse services

The correct answer is: Provision of supportive care and monitoring

In cases where a patient presents with symptoms consistent with psychosis following recent substance use, the initial approach should prioritize provision of supportive care and monitoring. This is essential because immediate intervention may not be necessary or appropriate, as the symptoms could be directly related to the substance use, which may require time to resolve on its own. Monitoring allows healthcare providers to assess the patient’s mental status and any potential risks, such as self-harm or harm to others, without rushing into medication or hospitalization unless absolutely warranted. Supportive care includes ensuring the patient's safety, providing reassurance, and setting a therapeutic environment, which can be crucial in managing acute psychosis, especially in the context of substance-induced symptoms. In contrast, hospitalization for psychiatric evaluation may not be immediately necessary unless the patient's condition warrants it due to severity or risk factors. Initiating antipsychotic medication right away may also be premature since it is important to first ascertain whether the symptoms will resolve as the substance clears from the system. Lastly, while referral to specialized substance abuse services can be an important step, it is often more beneficial to first stabilize the patient with support and monitoring in the acute phase.