Psychotic disorders: duration of an adequate antipsychotic trial: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Psychotic disorders: duration of an adequate antipsychotic trial

Sample item

A 21-year-old with first-episode schizophrenia has taken risperidone 4 mg daily for ten days with partial improvement and mild akathisia. His family asks to change the drug now. What is the best advice?

ASwitch to clozapine immediatelyBAdd a second antipsychoticCContinue the same dose and reassess at four to six weeksDDouble the dose at once

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Continue the same dose and reassess at four to six weeks

An antipsychotic should be given at an adequate dose for about four to six weeks before it is called a failure, and partial early improvement is encouraging. Clozapine is reserved for treatment resistance, defined by failure of two adequate trials.

Option by option

A. Switch to clozapine immediately
Clozapine is for treatment-resistant illness after two adequate trials of other drugs.
B. Add a second antipsychotic
Antipsychotic combinations are not first-line and increase adverse effects.
C. Continue the same dose and reassess at four to six weeks (correct)
Correct. An adequate trial lasts four to six weeks, and early improvement predicts response.
D. Double the dose at once
Doubling the dose does not speed response and would worsen akathisia and other adverse effects.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, Continue the same dose and reassess at four to six weeks. An antipsychotic should be given at an adequate dose for about four to six weeks before it is called a failure, and partial early improvement is encouraging.

Why is "Switch to clozapine immediately" not the answer?

Clozapine is for treatment-resistant illness after two adequate trials of other drugs.

Why is "Add a second antipsychotic" not the answer?

Antipsychotic combinations are not first-line and increase adverse effects.

Why is "Double the dose at once" not the answer?

Doubling the dose does not speed response and would worsen akathisia and other adverse effects.

What concept does this question test?

It tests Psychotic disorders: duration of an adequate antipsychotic trial in Psychiatry. Clozapine is reserved for treatment resistance, defined by failure of two adequate trials.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Psychotic disorders: duration of an adequate antipsychotic trial?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.