Which of the following psychotropic drugs would be most appropriate to try at this stage for the 29-year-old man with chronic paranoid schizophrenia?

Correct Answer: D

Rationale: The correct answer is D: Clozapine. Clozapine is the most appropriate choice for a 29-year-old man with chronic paranoid schizophrenia at this stage due to its efficacy in treatment-resistant cases and lower risk of extrapyramidal side effects. It is often considered a last resort due to its potential side effects, such as agranulocytosis, which requires regular monitoring. A: Fluphenazine and B: Thioridazine are typical antipsychotics with a higher risk of extrapyramidal side effects and are less effective in treatment-resistant cases compared to Clozapine. C: Fluoxetine is an antidepressant and not typically used as a first-line treatment for schizophrenia. It is more commonly used for depressive symptoms that may co-occur with schizophrenia.

Correct Answer: C

Rationale: Rationale: The correct answer is C because increased expression of brain-derived neurotrophic factor (BDNF) is a common mechanism underlying the therapeutic effectiveness of long-term therapy with most antidepressants. BDNF promotes neuronal survival, growth, and differentiation, which are essential for mood regulation and combating depression. A: Inhibition of central monoamine metabolism is a common mechanism of action for some antidepressants, but not all. B: Upregulation of central postsynaptic adrenoceptors is not a common mechanism of action for antidepressants. D: Decreased hippocampal neurogenesis is associated with depression, and antidepressants aim to increase neurogenesis.

Correct Answer: B

Rationale: The correct answer is B: 5-HT serotonergic receptors. This is because drugs that affect serotonin receptors can cause adverse effects such as serotonin syndrome, which presents with symptoms like confusion, agitation, and hyperthermia. Beta-1 adrenergic receptors (A) are involved in heart function, not typically associated with adverse effects. M cholinergic receptors (C) mediate the parasympathetic nervous system and are unlikely to cause adverse effects in this scenario. Alpha-1 adrenergic receptors (D) are involved in vasoconstriction and blood pressure regulation, not commonly linked to adverse drug effects in this context.

Correct Answer: A

Rationale: The correct answer is A: Bupropion. Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI), meaning it blocks the reuptake of both norepinephrine and dopamine by brain neurons, leading to increased levels of these neurotransmitters in the brain. This mechanism of action is specifically associated with bupropion and not the other choices. Methylphenidate primarily affects dopamine reuptake, Lamotrigine is an anticonvulsant that modulates glutamate release, and Aripiprazole is a partial dopamine agonist. Therefore, only bupropion matches the criteria of decreasing reuptake of both norepinephrine and dopamine.

Correct Answer: A

Rationale: The correct answer is A: Carbamazepine. It is appropriate for a patient planning to become pregnant due to its lower risk of teratogenic effects compared to other antiepileptic drugs. Carbamazepine is also recommended as a first-line treatment for epilepsy in pregnancy. Valproic acid (B) is contraindicated in pregnancy due to its high risk of causing neural tube defects. Quetiapine (C) and Haloperidol (D) are antipsychotic drugs not typically used for patients planning to become pregnant.