Psychotic disorders: first-episode psychosis with a substance trigger and safe next step: 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: first-episode psychosis with a substance trigger and safe next step

Sample item

A 19-year-old is brought with three days of fearfulness, hearing voices and refusing to eat, with an elevated pulse and dilated pupils. His friends say he took an unknown tablet at a party. He is oriented and calm enough to talk. Which is the best initial management?

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

The answer and the reasoning

B. Low-stimulus environment, observation, vital-sign monitoring and benzodiazepine if agitated

A drug-induced psychosis is managed supportively first, with a calm environment, monitoring of vital signs and hydration, and benzodiazepines for agitation, because antipsychotics can lower the seizure threshold and worsen autonomic instability. Drug screening and a plan for dependence follow, and an antipsychotic is used only if psychosis persists.

Option by option

  • A. Immediate high-dose antipsychotic loading

    High-dose antipsychotics risk seizures, QT prolongation and hyperthermia in a stimulant intoxication.

  • B. Low-stimulus environment, observation, vital-sign monitoring and benzodiazepine if agitated (correct)

    Correct. Supportive care, monitoring and benzodiazepines for agitation are first-line in a probable intoxication.

  • C. Start a long-acting injectable antipsychotic

    A depot injection is for established schizophrenia with adherence problems and is not appropriate in a suspected toxic state.

  • D. Discharge with reassurance and review in a month

    Discharge without monitoring is unsafe with abnormal vital signs and food refusal.

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.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Low-stimulus environment, observation, vital-sign monitoring and benzodiazepine if agitated. A drug-induced psychosis is managed supportively first, with a calm environment, monitoring of vital signs and hydration, and benzodiazepines for agitation, because antipsychotics can lower the seizure threshold and worsen autonomic instability.

Why is "Immediate high-dose antipsychotic loading" not the answer?

High-dose antipsychotics risk seizures, QT prolongation and hyperthermia in a stimulant intoxication.

Why is "Start a long-acting injectable antipsychotic" not the answer?

A depot injection is for established schizophrenia with adherence problems and is not appropriate in a suspected toxic state.

Why is "Discharge with reassurance and review in a month" not the answer?

Discharge without monitoring is unsafe with abnormal vital signs and food refusal.

What concept does this question test?

It tests Psychotic disorders: first-episode psychosis with a substance trigger and safe next step in Psychiatry. Drug screening and a plan for dependence follow, and an antipsychotic is used only if psychosis persists.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: first-episode psychosis with a substance trigger and safe next step?

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.