A 45-year-old man believes that his neighbors are spying on him and trying to poison his food. He hears voices discussing him, even when he is alone. He has no insight into his condition. What is the most appropriate treatment? A) Clozapine B) Olanzapine C) Diazepam D) Haloperidol + benzodiazepines E) CBT Correct Answer: B) Olanzapine Explanation: This patient has schizophrenia, characterized by delusions, auditory hallucinations, and lack of insight. Second-generation antipsychotics (SGAs) like Olanzapine or Risperidone are first-line treatments. A) Clozapine → Incorrect. Clozapine is reserved for treatment-resistant schizophrenia (failure of two antipsychotics). C) Diazepam → Incorrect. Diazepam is used for anxiety, not psychosis. D) Haloperidol + benzodiazepines → Incorrect. Haloperidol (a first-generation antipsychotic) is effective but has a higher risk of extrapyramidal side effects. E) CBT → Incorrect. CBT can be adjunctive but is not first-line treatment for active psychotic symptoms. Key Tips for PLAB 1: ✅ First-line treatment for schizophrenia = Second-generation antipsychotics (e.g., olanzapine, risperidone). ✅ Treatment-resistant schizophrenia (failure of 2 trials) → Clozapine. ✅ Acute agitation → Haloperidol or benzodiazepines (e.g., lorazepam).
