A client is having trouble remembering to take his antipsychotic medication, risperidone 3 mg PO, BID. The treatment team at the clinic he attends is considering starting him on risperidone 10 mg IM every 2 weeks. The rationale for this is:

Choice A Reason:

Labeling mild anxiety as pathologic and suggesting that it warrants postponing the test is not accurate. Mild anxiety is a normal response to stress and can actually be beneficial in certain situations. It helps to increase alertness and focus, which can improve performance on tasks such as taking a test. Pathologic anxiety, on the other hand, is excessive and persistent, interfering with daily functioning and requiring clinical intervention.

Choice B Reason:

The idea that mild anxiety may be transferred to classmates and result in generalized anxiety disorder is not supported by evidence. Anxiety is a personal experience and while it can be influenced by the environment, it is not something that can be directly transferred from one person to another. Generalized anxiety disorder is a chronic condition characterized by excessive worry about various aspects of life, and it develops due to a combination of genetic, environmental, and psychological factors.

Choice C Reason:

While severe anxiety can interfere with cognitive ability, mild anxiety typically does not. In fact, mild anxiety can enhance cognitive performance by increasing alertness and focus. It is only when anxiety becomes overwhelming that it starts to impair cognitive functions such as memory, attention, and problem-solving.

Choice D Reason:

Mild anxiety is conducive to concentration and problem-solving. This level of anxiety can act as a motivator, helping individuals to focus better and perform tasks more efficiently. The Yerkes-Dodson law suggests that there is an optimal level of arousal (including anxiety) that enhances performance. Too little arousal can lead to underperformance, while too much can cause performance to deteriorate.

Choice A Reason:

Pseudo-Parkinsonian side effects, also known as drug-induced parkinsonism, can occur with the use of antipsychotic medications like haloperidol. These side effects include symptoms such as rigidity, bradykinesia, tremor, and postural instability. However, the description of the client’s neck arched sharply backward is more indicative of an acute dystonic reaction rather than pseudo-Parkinsonian side effects. Pseudo-Parkinsonian symptoms typically develop more gradually and do not present with such dramatic posturing.

Choice B Reason:

While some side effects of haloperidol can be temporary and may disappear after several days, the acute dystonic reaction described in the scenario requires immediate intervention. Acute dystonic reactions are characterized by sudden, severe muscle contractions that can be painful and potentially dangerous if they involve the airway. Therefore, it is crucial to address this reaction promptly rather than waiting for it to resolve on its own.

Choice C Reason:

Increasing the dosage of haloperidol in response to the described symptoms would likely exacerbate the situation. The client’s symptoms are not indicative of worsening psychotic behavior but rather an adverse reaction to the medication. Increasing the dosage could lead to more severe side effects and complications. The appropriate response is to treat the acute dystonic reaction and reassess the medication regimen.

Choice D Reason:

An acute dystonic reaction is a known side effect of antipsychotic medications like haloperidol. It involves sudden, severe muscle contractions, often affecting the neck, face, and back. This reaction can be distressing and requires immediate treatment with anticholinergic medications such as benztropine or diphenhydramine. Prompt intervention can relieve the symptoms and prevent further complications.