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It's C. Initial treatment with risperidone oral until tolerability is established and continued for three weeks after LAI is administered.

Explanation: For patients with chronic psychotic symptoms who are not compliant with antipsychotic medication, an LAI or depot preparation should be considered after stabilization with oral medication. Risperdal Consta is a long-acting injectable form of risperidone; the recommended starting dosage is 25 mg every two weeks. It takes about three weeks (not two weeks; options B, D) for Risperdal Consta to build up adequate blood levels, thus oral risperidone or another antipsychotic medication must be continued for three weeks after the first dose of Risperdal Consta is given (option C) in order to prevent worsening of symptoms. Injections are given every two weeks, and steady-state plasma concentrations are achieved after four injections. Dose adjustments should not be made more often than once a month (option E); the maximum dose is 50 mg every two weeks. If a patient has not taken risperidone before, a trial of oral risperidone is recommended to determine whether the patient has a hypersensitivity reaction to the medication (option A).

Muskin PR and Dickerman AL, eds. Study Guide for the Psychiatry Board Examination. Arlington, VA: American Psychiatric Association Publishing; 2016: 80, 326. Click here to purchase. Members can purchase at a discount.