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Question12 of 50
Psychopharmacology

A 35-year-old woman with major depressive disorder has been taking sertraline 100 mg daily for 6 weeks with minimal improvement. Which is the most appropriate next step?

AAdd aripiprazole
BSwitch to venlafaxine
CIncrease sertraline to 200 mg
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Explanation, Q24 · Neurocognitive

Lewy body dementia

The triad of progressive cognitive decline, well-formed visual hallucinations of small animals or people, and parkinsonism with fluctuating attention is classic for dementia with Lewy bodies (DLB). REM sleep behavior disorder is often the earliest clue — sometimes preceding cognitive symptoms by years.

Avoid first-generation antipsychotics: patients with DLB have a profound neuroleptic sensitivity that can precipitate severe parkinsonism, autonomic instability, and worsening cognition. If a low-dose atypical is unavoidable, quetiapine is generally preferred.

TaggedDLBParkinsonismNeuroleptic sensitivity
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9:41
Tutor mode · Q24Mood disorders · Acute mania
07:42 elapsed

A 28-year-old presents with one week of decreased need for sleep, racing thoughts, and reckless spending. There is no prior depressive episode and no substance use. Vital signs are normal. Which is the most appropriate first-line monotherapy?

AFluoxetine
BLithium
CLorazepam
DMethylphenidate
Reasoning

Lithium remains first-line monotherapy for acute mania in patients without contraindications, with the strongest long-term evidence for preventing manic relapse. SSRIs alone risk manic switch in unipolar-presenting patients who are actually bipolar; benzodiazepines and stimulants treat neither the episode nor the underlying illness.

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After Q8

Augmentation strategy for partial SSRI response

A
Switch SSRI25%
B
Add aripiprazole50%
C
Increase dose25%
D
Add lithium0%
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