Behavioral Science & Ethics USMLE Step 1 Practice Question
A 28-year-old woman with panic disorder is started on paroxetine 20 mg daily. After 2 weeks of treatment, she reports decreased libido and delayed orgasm. When the prescriber explains that sexual side effects often resolve within 4-6 weeks and that the medication is effectively reducing her panic symptoms, the patient discontinues the medication without further discussion. Two months later, she presents to the emergency department with severe panic attacks and agoraphobia requiring hospitalization. Which of the following best explains the patient's decision to discontinue an effective treatment despite medical counseling?
Answer choices
- ALack of patient health literacy regarding selective serotonin reuptake inhibitor pharmacology
- BMedication nonadherence resulting from intolerable adverse effects and prioritization of quality of lifeCorrect answer
- CFailure of the prescriber to obtain informed consent before initiating pharmacotherapy
- DDevelopment of tachyphylaxis to paroxetine's therapeutic effects after 2 weeks
- EParoxetine-induced serotonin syndrome presenting with sexual dysfunction as a prodromal symptom
- FConversion of the underlying panic disorder into a somatic symptom disorder triggered by medication
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