Rosh Psychiatry Board Practice Exam

In a patient with schizophrenia experiencing dizziness, which medication is most likely responsible if the dose was recently increased?

1. Lurasidone

2. Prazosin

3. Quetiapine

4. Ziprasidone

The correct answer is: Quetiapine

In the context of a patient with schizophrenia experiencing dizziness after a recent dose increase, the medication most likely responsible is quetiapine. Quetiapine is known for its sedative properties and can cause sedation, hypotension, and dizziness, especially when the dose is adjusted upward. Increasing the dose of quetiapine can lead to a more pronounced effect on the central nervous system, which can contribute to dizziness. This side effect is particularly concerning in patients who may already be vulnerable due to the underlying condition or concurrent medications. While lurasidone and ziprasidone are also atypical antipsychotics, they have a lower incidence of sedation and orthostatic hypotension compared to quetiapine. Prazosin, an antihypertensive agent often used for nightmares in PTSD, can also cause dizziness, but is not typically first-line for schizophrenia and is less directly related to the condition itself. Thus, quetiapine stands out as the medication most closely associated with the symptoms described when its dose is increased.