In choosing a benzodiazepine to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepine with the greatest likelihood of causing rapidly developing dependence is:

Impetigo is a highly contagious superficial bacterial skin infection commonly caused by Staphylococcus aureusand sometimes Streptococcus pyogenes. It typically presents as honey-colored crusted lesions and is most often managed with topical or systemic antibiotics depending on severity and extent. Localized, mild cases are best treated with topical agents to limit systemic exposure and effectively eradicate the infection. Early treatment also helps prevent spread to others and further skin involvement.

Rationale:
A. Miconazole (Lotrimin) is an antifungal agent used to treat fungal infections such as tinea corporis or candidiasis. Since impetigo is a bacterial infection, miconazole has no activity against Staphylococcus aureusor Streptococcus pyogenes. Using an antifungal would not resolve the infection and could allow progression or spread.

B. Mupirocin (Bactroban) is the first-line treatment for mild, localized impetigo. It works by inhibiting bacterial protein synthesis, effectively targeting common causative organisms such as Staphylococcus aureus. For limited lesions, topical therapy is preferred because it is highly effective, reduces systemic side effects, and directly treats the infected skin area.

C. Amoxicillin-clavulanate (Augmentin) is an oral antibiotic reserved for more extensive, severe, or systemic infections. While it has activity against common impetigo pathogens, it is not necessary for mild localized lesions. Oral therapy increases systemic exposure and is typically avoided when topical treatment is sufficient.

D. Cephalexin (Keflex) is effective against many gram-positive organisms and may be used for more widespread impetigo. However, for 2–3 localized lesions, systemic therapy is not indicated as first-line management. Topical treatment is equally effective in mild cases and minimizes unnecessary antibiotic exposure.

Chlorpromazine (Thorazine) is a first-generation antipsychotic used in schizophrenia, primarily effective for positive symptoms such as hallucinations and delusions. However, typical antipsychotics can worsen or fail to improve negative symptoms like flat affect, social withdrawal, and poor self-care. Negative symptoms are more closely linked to dopamine dysfunction in the mesocortical pathway and respond better to medications with broader dopamine-serotonin activity. Treatment adjustment is often needed when negative symptoms predominate or worsen.

Rationale:
A. Switching to lithium such as Lithium (Lithobid) is not appropriate because lithium is used for bipolar disorder and mood stabilization, not for primary treatment of schizophrenia negative symptoms. It does not address psychotic symptoms or negative symptom clusters such as avolition or flat affect.

B. Switching to another typical antipsychotic like Haloperidol (Haldol) would likely not improve negative symptoms and may further exacerbate them due to strong dopamine D2 blockade. Typical antipsychotics are more effective for positive symptoms and are associated with extrapyramidal side effects, which can worsen functional impairment and social withdrawal.

C. Switching to an atypical antipsychotic such as Risperidone (Risperdal) is appropriate because atypical agents target both dopamine and serotonin receptors, providing better coverage for both positive and negative symptoms. These medications are more effective in improving affect, motivation, and social functioning compared to typical antipsychotics. They also have a lower risk of extrapyramidal side effects at standard doses.

D. Increasing the dose of Chlorpromazine (Thorazine) is not appropriate because it may worsen side effects without improving negative symptoms. Higher doses increase the risk of sedation, anticholinergic effects, and extrapyramidal symptoms, all of which can further impair functioning and quality of life. Negative symptoms are not dose-responsive to typical antipsychotic escalation.