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Seasonal pattern depression — USMLE Step 3 MCQ

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HardPsychiatrySeasonal pattern depressionUSMLE Step 3

A 62-year-old with schizophrenia is stable on the lowest effective dose of an antipsychotic but has persistent lip smacking, tongue protrusion and choreiform finger movements that impair eating. AIMS scores remain elevated. What is the best targeted treatment?

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Correct answer: C — Add a reversible VMAT2 inhibitor such as valbenazine

The best answer is “Add a reversible VMAT2 inhibitor such as valbenazine”. This is functionally significant tardive dyskinesia, for which a VMAT2 inhibitor is recommended. Anticholinergic therapy can worsen tardive movements, propranolol is used more often for akathisia, and abrupt withdrawal risks psychotic relapse and may transiently unmask dyskinesia.

Reference: APA Practice Guideline for the Treatment of Patients With Schizophrenia: https://psychiatryonline.org/doi/10.1176/appi.ajp.2020.177901