# Situation: A nurse at a Rural Health Unit (RHU) who uses the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) cares for a 23-year-old man with a first episode of psychosis. Before treatment he had heard voices and believed his neighbors were poisoning his food for 3 weeks. Physical causes, substance use, and mania were ruled out, and oral haloperidol was started at a low dose. All his psychotic symptoms resolved 7 weeks after haloperidol was started. Seven months after that he remains well, takes the tablets daily, and asks to stop them. Which plan BEST follows mhGAP-IG?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630102  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse at a Rural Health Unit (RHU) who uses the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) cares for a 23-year-old man with a first episode of psychosis. Before treatment he had heard voices and believed his neighbors were poisoning his food for 3 weeks. Physical causes, substance use, and mania were ruled out, and oral haloperidol was started at a low dose.

All his psychotic symptoms resolved 7 weeks after haloperidol was started. Seven months after that he remains well, takes the tablets daily, and asks to stop them. Which plan BEST follows mhGAP-IG?

## 보기

1. Reduce the dose gradually over the next month, as he is stable
2. Stop the tablets now and restart them if the voices come back
3. Continue for 5 more months, then reduce the dose gradually **✔ 정답**
4. Continue until he has been in full remission for several years

**정답: 3**

## 해설

His psychotic symptoms lasted about 10 weeks in total (3 weeks before and 7 weeks on treatment), which is not more than 3 months. For a first episode, mhGAP-IG advises considering discontinuation 12 months after symptoms have resolved; he has been well for 7 months, so 5 more months remain, after which the dose is reduced gradually while the family learns early relapse signs. Remission for several years is required only when symptoms persisted for more than 3 months.

## 심화 해설

Work out the duration first
The mhGAP-IG rule for stopping antipsychotic medicine after psychosis depends on how long the symptoms lasted and whether this is a first episode. This client heard voices and believed his neighbors were poisoning him for 3 weeks before treatment, and his symptoms resolved 7 weeks after haloperidol was started. His total duration of symptoms was about 10 weeks, which is not more than 3 months. For a first episode, mhGAP-IG advises considering discontinuation 12 months after symptoms have resolved; he has been well for 7 months, so 5 more months remain, followed by gradual dose reduction.

| Situation | When to consider stopping |
| --- | --- |
| First episode, symptoms resolved | 12 months after resolution |
| Symptoms persisted more than 3 months | Several years of full remission |
| In all cases | Reduce gradually; teach early relapse signs |

The arithmetic
Twelve months after resolution minus the 7 months already passed leaves 5 months of continued treatment. After that, the dose is reduced gradually over weeks, never stopped abruptly, while the client and family learn the early signs of relapse, such as poor sleep, suspiciousness, withdrawal, or return of voices, and know where to seek help quickly. Follow-up continues during and after the reduction.

Why the other plans are wrong
Reducing the dose now over the next month stops treatment before the 12 months advised after a first episode, raising the risk of relapse. Stopping the tablets now and restarting them only if voices return is both too early and abrupt; sudden discontinuation increases relapse risk. Continuing until several years of full remission applies when symptoms persisted for more than 3 months, which is not the case here.

Watch out! His request to stop deserves a respectful conversation, not dismissal. Explaining the reasons for 5 more months, agreeing on a plan, and involving his family support adherence. Also watch for haloperidol side effects, such as stiffness or restlessness, that may motivate him to stop.

Exam takeaway
Key point! Add up symptom duration before and during treatment; if it is not more than 3 months and this is a first episode, consider stopping 12 months after resolution, with gradual reduction. Several years of remission apply only when symptoms persisted beyond 3 months.

## 임상 시나리오

When to Stop AntipsychoticsmhGAP-IG first-episode psychosis
Symptoms lasted 3 weeks before and 7 weeks on treatment, about 10 weeks in total, not more than 3 months.

For a first episode, consider stopping 12 months after symptoms resolve. He has been well 7 months, so continue 5 more months, then reduce gradually.

Teach him and his family the early signs of relapse and where to seek help, and continue follow-up.

CautionDo not stop abruptly or early; several years of remission are required only when symptoms lasted more than 3 months.

## 핵심 개념

- **First-episode psychosis** — The first occurrence of psychotic symptoms such as hallucinations and delusions.
- **Haloperidol** — A first-generation antipsychotic that can cause extrapyramidal side effects such as stiffness and restlessness.
- **Relapse** — Return of symptoms after a period of improvement.
- **Gradual dose reduction** — Slow tapering of a medicine over weeks to lower the risk of relapse or withdrawal effects.

## 같은 주제 문제

- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629986)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629987)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629988)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629989)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629990)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629991)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629992)
- [Situation: A 40-year-old woman is admitted to the psychiatric ward with major depressive d…](https://mymerci.kr/pages/nclex_q.php?qn_id=629993)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._