USMLE Step 2 Quiz: Psychotic Disorders
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Psychotic DisordersQuestion 1 of 20

A 25-year-old woman is brought to the emergency department by her family due to a 2-week history of acute-onset bizarre behavior, disorganized speech, and auditory hallucinations. Her symptoms began shortly after she was unexpectedly fired from her job. Her family reports no prior psychiatric history or substance use. She is oriented to person and place but not time. Her reality testing is poor.

What is the most likely diagnosis?

Schizophrenia
Schizophreniform disorder
Brief psychotic disorder
Acute stress disorder
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USMLE Step 2 Quiz

USMLE Step 2 Quiz: Psychotic Disorders

Practice Psychotic Disorders in USMLE Step 2 with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Psychotic Disorders, giving you a quick way to practice the rules, question types, and explanations that matter most for USMLE Step 2.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A 25-year-old woman is brought to the emergency department by her family due to a 2-week history of acute-onset bizarre behavior, disorganized speech, and auditory hallucinations. Her symptoms began shortly after she was unexpectedly fired from her job. Her family reports no prior psychiatric history or substance use. She is oriented to person and place but not time. Her reality testing is poor.

What is the most likely diagnosis?

  1. Schizophrenia
  2. Schizophreniform disorder
  3. Brief psychotic disorder (correct answer)
  4. Acute stress disorder

Explanation: The patient's acute onset of psychotic symptoms (hallucinations, disorganized speech) lasting for 2 weeks in the context of a significant psychosocial stressor is characteristic of brief psychotic disorder. By definition, the symptoms last from one day to one month, with an eventual full return to premorbid functioning.

  • Schizophrenia and schizophreniform disorder are incorrect due to the short duration of symptoms (less than 6 months and 1 month, respectively).
  • Acute stress disorder involves intrusive symptoms, avoidance, and hyperarousal following a traumatic event, but does not typically include prominent psychotic symptoms like hallucinations and disorganized speech.

Question 2

A 55-year-old accountant has the fixed, unshakeable belief that his wife is having an affair. This belief has persisted for over a year, despite his wife's protestations and a lack of any concrete evidence. He has hired private investigators twice, both of whom found no proof of infidelity. Apart from this specific belief and its ramifications (e.g., arguing with his wife), his functioning is unimpaired. He continues to excel at his job and maintains his friendships. He denies any hallucinations, disorganized thoughts, or negative symptoms.

What is the most likely diagnosis?

  1. Schizophrenia, paranoid type
  2. Paranoid personality disorder
  3. Delusional disorder (correct answer)
  4. Schizoaffective disorder

Explanation: This patient's presentation is classic for delusional disorder. The key features are one or more non-bizarre delusions (in this case, jealous type) that persist for at least one month, without the other psychotic symptoms seen in schizophrenia (e.g., hallucinations, disorganized speech). Crucially, functioning outside the impact of the delusion is not markedly impaired.

  • Schizophrenia is incorrect because the patient lacks other Criterion A symptoms and his overall functioning is not significantly impaired.
  • Paranoid personality disorder involves a pervasive distrust and suspiciousness of others, but not a fixed, false belief of this magnitude.
  • Schizoaffective disorder is incorrect as there are no mood episodes or other psychotic symptoms.

Question 3

A 30-year-old woman with a history of psychosis is evaluated. Over the past year, she has experienced continuous auditory hallucinations and persecutory delusions. During this time, she also had a distinct 3-month period of severe depression with anhedonia, hopelessness, and suicidal ideation. Outside of this depressive episode, her psychotic symptoms have remained present. Her medical history is otherwise unremarkable.

What is the most likely diagnosis?

  1. Bipolar I disorder with psychotic features
  2. Major depressive disorder with psychotic features
  3. Schizophrenia
  4. Schizoaffective disorder (correct answer)

Explanation: Schizoaffective disorder is diagnosed when a patient meets the criteria for a major mood episode (depressive or manic) that occurs concurrently with the active-phase symptoms of schizophrenia. The key diagnostic feature is the presence of delusions or hallucinations for at least 2 weeks in the absence of a major mood episode during the lifetime duration of the illness. This patient has persistent psychosis with a superimposed major depressive episode, fitting the criteria for schizoaffective disorder.

  • Major depressive disorder with psychotic features is incorrect because the psychosis persists even when the mood episode resolves.
  • Bipolar I disorder with psychotic features is incorrect for the same reason, and there is no evidence of a manic episode.
  • Schizophrenia is incorrect because the mood symptoms are prominent and meet the criteria for a full major depressive episode.

Question 4

A 24-year-old man is brought to the emergency department by police for bizarre and aggressive behavior in public. He is extremely agitated and paranoid, believing that insects are crawling under his skin. On physical examination, he is diaphoretic and has dilated pupils. His heart rate is 130/min and his blood pressure is 160/95 mmHg. Numerous excoriations are noted on his arms and face, and he has significant dental erosion and decay.

The patient's psychotic symptoms are most likely caused by intoxication with which of the following substances?

  1. Alcohol
  2. Heroin
  3. Methamphetamine (correct answer)
  4. Cannabis

Explanation: This clinical picture is classic for methamphetamine-induced psychosis. Key features include paranoia, agitation, sympathetic hyperactivity (tachycardia, hypertension, mydriasis, diaphoresis), and tactile hallucinations (formication, or the sensation of bugs crawling on the skin). The skin excoriations from picking at these perceived bugs and the poor dental hygiene ('meth mouth') are also highly suggestive.

  • Alcohol intoxication typically causes sedation, while withdrawal can cause hallucinations, but the overall picture is less consistent.
  • Heroin (an opioid) causes miosis (constricted pupils) and CNS depression.
  • Cannabis can induce psychosis, but it is less likely to cause such profound sympathetic stimulation and formication.

Question 5

A 21-year-old man presents to his primary care physician with a 2-month history of new-onset paranoid delusions and auditory hallucinations. He has no prior psychiatric history and this is his first episode of psychosis. He denies any recent trauma or significant stressors. A physical examination, including a neurologic exam, is within normal limits. His vital signs are stable.

In addition to a comprehensive psychiatric history, which of the following is the most important initial step in the diagnostic workup?

  1. Electroencephalogram (EEG)
  2. Urine toxicology screen and basic metabolic panel (correct answer)
  3. Lumbar puncture for CSF analysis
  4. Genetic testing for schizophrenia risk alleles

Explanation: For any patient presenting with a first episode of psychosis, it is crucial to rule out medical and substance-induced causes. A standard initial workup includes a complete physical and neurologic exam, basic laboratory tests (e.g., CBC, electrolytes, BUN, creatinine, LFTs, TSH), and a urine toxicology screen to rule out substance-induced psychotic disorder. This ensures that a treatable underlying condition is not missed before diagnosing a primary psychotic disorder.

  • An EEG or lumbar puncture would be indicated if there were specific signs suggesting a seizure disorder or CNS infection, which are not present here.
  • Genetic testing is not part of the routine clinical workup for schizophrenia.

Question 6

A 34-year-old man with a 10-year history of schizophrenia has had four hospitalizations in the past two years due to psychotic relapses. Each relapse was preceded by him discontinuing his oral olanzapine. During a clinic visit, he acknowledges that he has difficulty remembering to take his medication every day but is willing to consider other options to prevent future hospitalizations. His positive symptoms are currently controlled.

Which of the following interventions would be most effective in reducing this patient's risk of relapse?

  1. Switching him to oral clozapine
  2. Initiating a long-acting injectable antipsychotic (correct answer)
  3. Adding a daily benzodiazepine for anxiety
  4. Enrolling him in weekly group therapy

Explanation: For patients with schizophrenia who have a history of nonadherence to oral medication, long-acting injectable (LAI) antipsychotics are the most effective strategy for improving adherence and reducing relapse rates. An LAI, such as paliperidone palmitate or aripiprazole lauroxil, is administered every few weeks to months, bypassing the need for daily oral dosing.

  • Switching to oral clozapine is indicated for treatment-resistant schizophrenia, not nonadherence.
  • Adding a benzodiazepine does not address the core issue of antipsychotic nonadherence.
  • Group therapy can be a useful adjunct, but it is less effective than an LAI for solving the specific problem of medication nonadherence.

Question 7

A 42-year-old man with chronic schizophrenia is maintained on a stable dose of risperidone. His auditory hallucinations are no longer present, and his paranoid thoughts have resolved. However, he continues to struggle with a profound lack of motivation, inability to experience pleasure, and a blunted affect. These negative symptoms significantly impair his ability to maintain relationships and employment.

Which of the following is the most effective intervention for these persistent symptoms?

  1. Increasing the dose of risperidone
  2. Adding benztropine to his medication regimen
  3. Switching to a first-generation antipsychotic like haloperidol
  4. Implementing a psychosocial intervention like social skills training (correct answer)

Explanation: While antipsychotic medications are effective for the positive symptoms of schizophrenia, they have limited efficacy for negative symptoms (avolition, anhedonia, flat affect, etc.). Evidence-based psychosocial interventions, such as social skills training, supported employment, and cognitive-behavioral therapy for psychosis, are the most effective treatments for improving functional outcomes and addressing persistent negative symptoms.

  • Increasing the risperidone dose is unlikely to help with negative symptoms and may worsen them or cause side effects.
  • Adding benztropine would only be indicated for extrapyramidal symptoms, not primary negative symptoms.
  • Switching to a first-generation antipsychotic is generally associated with worse negative symptoms compared to second-generation agents.

Question 8

A 23-year-old man with a first psychotic episode is started on haloperidol in the hospital. On the third day of treatment, he complains of a stiff neck and is observed to have a sustained, painful, upward deviation of his eyes and twisting of his neck to one side. He is in significant distress.

Which of the following is the most appropriate immediate treatment?

  1. Intravenous lorazepam
  2. Intramuscular benztropine (correct answer)
  3. Oral propranolol
  4. Discontinue haloperidol

Explanation: The patient is experiencing an acute dystonic reaction, a type of extrapyramidal side effect (EPS) common with high-potency first-generation antipsychotics like haloperidol. The symptoms include oculogyric crisis (upward eye deviation) and torticollis (neck twisting). The treatment of choice is an intramuscular injection of an anticholinergic agent like benztropine or an antihistamine with anticholinergic properties like diphenhydramine, which provides rapid relief.

  • Lorazepam can help with associated anxiety but is not the primary treatment.
  • Propranolol is used to treat akathisia, another form of EPS.
  • Discontinuing haloperidol is a long-term consideration, but the acute, painful reaction requires immediate pharmacologic intervention.

Question 9

A 58-year-old man with chronic schizophrenia has been treated with risperidone 6 mg/day for the past five years. His wife brings him to the clinic because she has noticed he has become progressively slower, has a tremor in his hands at rest, and walks with a shuffling gait. On examination, you note a masked facies, cogwheel rigidity, and a resting pill-rolling tremor.

Which of the following is the most appropriate management step?

  1. Start treatment with levodopa/carbidopa
  2. Increase the dose of risperidone to better control symptoms
  3. Add an anticholinergic agent such as benztropine (correct answer)
  4. Obtain a brain MRI to rule out a stroke

Explanation: The patient is exhibiting signs of drug-induced parkinsonism, a common extrapyramidal side effect of antipsychotics with potent D2 receptor blockade, like risperidone. The symptoms include bradykinesia, rigidity, and tremor. The most appropriate management options are to lower the dose of the antipsychotic, switch to an agent with a lower risk of EPS (e.g., quetiapine), or add an anticholinergic medication like benztropine or amantadine. Adding benztropine is a common and effective initial strategy.

  • Levodopa/carbidopa is used for Parkinson's disease and can worsen psychosis.
  • Increasing the risperidone dose would worsen the parkinsonian symptoms.
  • A brain MRI is not indicated as the clinical picture is highly suggestive of a medication side effect, not a new neurologic event.

Question 10

A 65-year-old woman with a 20-year history of schizoaffective disorder, treated for many years with haloperidol, presents for a follow-up visit. Her daughter expresses concern about new, involuntary movements she has been making for the past few months. On examination, the patient exhibits repetitive, choreoathetoid movements of her mouth and tongue, including lip-smacking and facial grimacing. She seems unaware of the movements.

Which of the following is the most appropriate next step in management?

  1. Increase the dose of haloperidol to suppress the movements
  2. Add benztropine to treat the extrapyramidal symptoms
  3. Initiate treatment with a VMAT2 inhibitor like valbenazine (correct answer)
  4. Reassure the family that this is a benign, self-limiting condition

Explanation: This patient is presenting with classic signs of tardive dyskinesia (TD), a potentially irreversible movement disorder caused by long-term exposure to dopamine-blocking agents. Management involves discontinuing the offending agent if possible and switching to an antipsychotic with lower TD risk (like clozapine). If symptoms persist or the antipsychotic cannot be stopped, the treatment of choice is a vesicular monoamine transporter 2 (VMAT2) inhibitor, such as valbenazine or deutetrabenazine.

  • Increasing the antipsychotic dose can temporarily mask TD but ultimately worsens the underlying pathology.
  • Adding benztropine or other anticholinergics can worsen TD.
  • Reassurance is inappropriate as TD can be disfiguring, distressing, and is not always self-limiting.

Question 11

A 30-year-old man with schizophrenia is brought to the emergency department from his group home due to a sudden change in mental status. He was started on fluphenazine two weeks ago. He is now febrile to 40.1°C (104.2°F), confused, and diaphoretic. His blood pressure is 170/110 mmHg and his pulse is 125/min. On physical examination, he has diffuse, severe 'lead-pipe' rigidity. Laboratory results are notable for a creatine kinase level of 20,000 U/L and leukocytosis.

Which of the following is the most critical initial step in this patient's management?

  1. Administer intravenous dantrolene
  2. Obtain a lumbar puncture to rule out meningitis
  3. Discontinue fluphenazine immediately (correct answer)
  4. Start empiric broad-spectrum antibiotics

Explanation: This patient's presentation of fever, autonomic instability (hypertension, tachycardia), altered mental status, and severe muscle rigidity ('lead-pipe') in the setting of recent antipsychotic initiation is classic for Neuroleptic Malignant Syndrome (NMS), a medical emergency. The single most important first step is to discontinue the offending antipsychotic agent. This is followed by aggressive supportive care (IV fluids, cooling blankets) and consideration of specific treatments like dantrolene or bromocriptine.

  • Administering dantrolene is an appropriate treatment, but only after the offending agent has been stopped.
  • While the presentation can mimic meningitis, the pronounced rigidity and extremely high CK make NMS far more likely, and stopping the drug is the priority.
  • Antibiotics might be considered, but the primary diagnosis is NMS.

Question 12

A 28-year-old woman with schizophrenia has been treated with paliperidone for the past year. She presents to her psychiatrist complaining of amenorrhea for the last 6 months and a milky discharge from her breasts. She is concerned and asks what might be causing these symptoms. A pregnancy test is negative.

Which of the following is the most appropriate next step to evaluate her symptoms?

  1. Obtain a serum prolactin level (correct answer)
  2. Switch her medication to aripiprazole
  3. Reassure her that this is a benign side effect
  4. Refer her for a pituitary MRI

Explanation: The patient's symptoms of amenorrhea and galactorrhea are highly suggestive of hyperprolactinemia, a common side effect of antipsychotics that are potent dopamine D2 receptor antagonists, such as paliperidone and risperidone. The first step in the workup is to confirm the diagnosis by measuring a serum prolactin level.

  • Switching the medication is a potential management step but should be done only after confirming the diagnosis and considering the risks/benefits.
  • Reassurance is not appropriate without first confirming the cause and discussing the implications (e.g., risk of osteoporosis).
  • A pituitary MRI would be considered if the prolactin level is extremely high or if a prolactinoma is suspected, but it is not the initial step.

Question 13

A 31-year-old woman with bipolar I disorder was started on lurasidone one month ago. She reports that her mood is stable, but she feels an intense inner restlessness and a compulsion to move. She tells you, "I feel like I'm crawling out of my skin and I can't sit still." During the interview, she is constantly shifting in her seat and tapping her feet.

Which of the following is the most appropriate initial pharmacologic treatment for this patient's symptoms?

  1. Benztropine
  2. Propranolol (correct answer)
  3. Cyproheptadine
  4. Amantadine

Explanation: This patient is describing akathisia, an extrapyramidal side effect characterized by a subjective feeling of inner restlessness and objective signs of repetitive movements. It is a common side effect of many antipsychotics. The first-line treatment for akathisia is to reduce the dose of the offending agent if possible. If not, the most effective pharmacologic treatments are beta-blockers (e.g., propranolol), followed by benzodiazepines or anticholinergics.

  • Benztropine is more effective for dystonia and parkinsonism than for akathisia.
  • Cyproheptadine is used for serotonin syndrome.
  • Amantadine is sometimes used for drug-induced parkinsonism.

Question 14

A 28-year-old man with a known history of schizophrenia is brought to the emergency department by ambulance for acute agitation. He is pacing, yelling, and appears to be responding to internal stimuli. He is uncooperative with attempts at verbal de-escalation and refuses to take any oral medication. He is perceived as a potential danger to himself and the staff.

Which of the following is the most appropriate next step in management?

  1. Administer olanzapine intramuscularly (correct answer)
  2. Administer lorazepam orally
  3. Apply four-point physical restraints
  4. Obtain an urgent head CT scan

Explanation: In an acutely agitated and psychotic patient who is uncooperative with oral medication, the standard of care is rapid tranquilization with an intramuscular antipsychotic. A second-generation antipsychotic like olanzapine or ziprasidone, or a first-generation agent like haloperidol, is effective and appropriate. This allows for rapid control of agitation and psychosis.

  • Administering lorazepam orally is not feasible as the patient is refusing oral medications.
  • Applying physical restraints may be necessary for safety but should be used in conjunction with pharmacologic intervention. Medication is the primary treatment for the underlying psychosis and agitation.
  • Obtaining a head CT scan is not the immediate priority. The patient's agitation must be controlled first, and his presentation is consistent with an exacerbation of his known schizophrenia.

Question 15

A 19-year-old college sophomore is brought to the student health center by her roommate, who is concerned about her behavior over the past 3 months. The patient has been spending most of her time in her room, expressing fears that her classmates are plotting against her. She also reports hearing voices whispering her name. Her academic performance has significantly deteriorated. She denies any illicit drug use or significant mood changes such as depression or mania. Her symptoms have been continuous over the 3-month period.

What is the most likely diagnosis?

  1. Schizophrenia
  2. Schizophreniform disorder (correct answer)
  3. Brief psychotic disorder
  4. Delusional disorder

Explanation: This patient presents with classic symptoms of psychosis, including delusions and hallucinations, along with a decline in functioning. The key diagnostic feature is the duration of symptoms. Schizophreniform disorder is diagnosed when symptoms last between one and six months. Since her symptoms have been present for 3 months, this is the most fitting diagnosis.

  • Schizophrenia is incorrect because the diagnostic criteria require a duration of at least six months.
  • Brief psychotic disorder is incorrect because symptoms last for less than one month.
  • Delusional disorder is incorrect because the patient exhibits hallucinations and a significant decline in functioning, which are not characteristic of delusional disorder.

Question 16

A 78-year-old resident of a nursing home with a history of moderate Alzheimer dementia is brought to the emergency department for evaluation of new-onset agitation and visual hallucinations that began yesterday. The nursing staff reports that he has been more confused than usual, and his level of awareness seems to fluctuate throughout the day. His vital signs are: temperature 38.5°C (101.3°F), blood pressure 100/60 mmHg, heart rate 110/min, and respirations 20/min. A urinalysis is performed.

The patient's acute change in mental status is most likely due to which of the following?

  1. Progression of his underlying dementia
  2. Late-onset schizophrenia
  3. Delirium secondary to an infection (correct answer)
  4. Anticholinergic medication toxicity

Explanation: This patient's acute onset of altered mental status, fluctuating course, and attentional deficits, superimposed on a chronic dementia, is characteristic of delirium. The presence of fever, tachycardia, and hypotension strongly suggests an underlying medical cause, such as a urinary tract infection or pneumonia. Differentiating primary psychosis from psychosis secondary to a medical condition is crucial.

  • Progression of dementia is typically gradual, not acute over one day.
  • Late-onset schizophrenia is rare and would not explain the fluctuating consciousness or vital sign abnormalities.
  • Anticholinergic toxicity is a possible cause of delirium, but the signs of infection make it the most likely etiology in this case.

Question 17

A 29-year-old man with schizophrenia continues to experience severe, persistent command hallucinations and persecutory delusions despite compliant, therapeutic trials of both oral risperidone and oral aripiprazole over the past three years. His symptoms cause significant distress and functional impairment, including an inability to work or live independently. His psychiatrist is considering a change in medication.

Which of the following is the most appropriate next step in pharmacologic management?

  1. Switch to clozapine (correct answer)
  2. Add lithium to his current regimen
  3. Switch to haloperidol decanoate
  4. Augment with an antidepressant

Explanation: This patient has treatment-resistant schizophrenia (TRS), which is defined as a failure to respond to at least two adequate trials of different antipsychotic medications. Clozapine is the only medication with proven efficacy for TRS and is the standard of care in this situation.

  • Adding lithium or an antidepressant is not an evidence-based strategy for refractory positive symptoms of schizophrenia.
  • Switching to haloperidol decanoate is unlikely to be effective, as he has already failed to respond to two different classes of antipsychotics, and switching to another typical or atypical agent (other than clozapine) has a low probability of success.

Question 18

A 22-year-old man is brought to the clinic by his parents due to an 8-month history of behavioral changes. His parents report that he has become increasingly socially withdrawn, his grades in college have declined precipitously, and he has developed odd beliefs, such as thinking that television news anchors are sending him secret messages. The patient states he hears voices that provide a running commentary on his actions. On mental status examination, he has a flat affect and his speech is tangential and difficult to follow. He has no history of substance use, and a urine toxicology screen is negative. Physical examination and basic laboratory studies are unremarkable.

What is the most likely diagnosis?

  1. Brief psychotic disorder
  2. Schizophreniform disorder
  3. Schizophrenia (correct answer)
  4. Schizoaffective disorder

Explanation: The patient's presentation of positive symptoms (delusions, auditory hallucinations), negative symptoms (flat affect, social withdrawal), and disorganized thought/speech, coupled with a significant decline in functioning for a duration of 8 months, meets the DSM-5 criteria for schizophrenia. The symptoms must be present for at least 6 months for this diagnosis.

  • Brief psychotic disorder is incorrect because the symptoms have lasted for more than one month.
  • Schizophreniform disorder is incorrect because the symptoms have lasted for more than six months.
  • Schizoaffective disorder is incorrect as there is no mention of a major depressive or manic episode occurring concurrently with the psychotic symptoms.

Question 19

A 40-year-old man with schizoaffective disorder has been treated with olanzapine for the past two years. His psychiatric symptoms are well-controlled. During a routine follow-up, his weight is noted to have increased by 15 kg (33 lbs) since starting the medication, and his BMI is now 32 kg/m². His blood pressure is 145/90 mmHg.

Which of the following screening tests is most important to perform at this time?

  1. Serum prolactin level
  2. Complete blood count
  3. Electrocardiogram
  4. Fasting lipid panel and HbA1c (correct answer)

Explanation: Second-generation antipsychotics, particularly olanzapine and clozapine, are associated with a high risk of metabolic syndrome, which includes weight gain, dyslipidemia, hyperglycemia, and hypertension. Given this patient's significant weight gain and elevated blood pressure, it is essential to screen for the other components of metabolic syndrome by checking a fasting lipid panel and a hemoglobin A1c (or fasting glucose).

  • Serum prolactin is more commonly elevated with agents like risperidone and paliperidone.
  • Complete blood count is not part of routine metabolic monitoring.
  • An ECG is important to obtain at baseline and periodically for QTc monitoring, but the immediate concern raised by the vignette is metabolic syndrome.

Question 20

A 35-year-old woman with treatment-resistant schizoaffective disorder is initiated on clozapine. Her psychiatrist explains that this medication requires a special monitoring program due to a potentially life-threatening side effect.

Which of the following adverse effects necessitates weekly blood monitoring for the first six months of clozapine therapy?

  1. Agranulocytosis (correct answer)
  2. Metabolic syndrome
  3. Myocarditis
  4. Prolonged QTc interval

Explanation: Clozapine carries a risk of severe neutropenia, including agranulocytosis, which can be fatal. Due to this risk, patients taking clozapine must be enrolled in a Risk Evaluation and Mitigation Strategy (REMS) program that requires regular monitoring of the absolute neutrophil count (ANC). Monitoring is weekly for the first 6 months, then bi-weekly for the next 6 months, and monthly thereafter.

  • Metabolic syndrome is a significant risk with clozapine, but monitoring involves periodic checks of weight, glucose, and lipids, not weekly blood draws.
  • Myocarditis is a rare but serious side effect, especially in the first month, but is monitored for clinically (fever, chest pain) and with inflammatory markers if suspected, not with routine weekly blood tests.
  • Prolonged QTc interval is a risk with many antipsychotics, monitored with a baseline and periodic ECG.