tsk tsk people aren't being very helpful in thinking about this case as psychopharmacologists. We need to use the full therapeutic armamentarium to help our patients find new routes to wellness through the advances in biological psychiatry.
If I were a radical psychopharmacologist I would probably prescribe this patient 300mg clomipramine to modulate aberrant orbitofrontal cortex activity leading to her obsessional fixation on bus drivers, 0.25mg tid (titrated liberally as needed) of alprazolam for her anxiety that leads to the compulsion neurosis discharging her anxiety in this way, 50mg naltrexone qam to block the endogenous opioids necessarily released when talking to bus drivers which reinforce this behavior, 16mg prazosin qhs will suppress alpha-1 adrenergic receptors and increse R sleep helping with the nightmares she is undoubtedly experiencing from the trauma of the incident with the bus driver, 1mg of risperidone to suppress cortioco-thalamic-striatal activation and rumination from the narcissistic injury, and 90mg of Adderall because she too deserves to find new chemical living and optimal functioning through psychopharmacology. Increasing the alprazolam as needed to curtail any anxiety from the adderall is advisable.
One might also consider pramipexole 0.75mg qhs for a possible severe restless leg syndrome that leads her to fervently hop the bus routes, a combination of 10mg donepezil and 10mg bid of memantine to treat possible wandering behavior in vascular dementia, 20mg vortioxetine to establish a therapeutic alliance, IV depakote 45mg/kg for a possible non-convulsive status epilepticus leading to repetitive behaviors, heroic doses of lorazepam starting at 2mg tid for possible excited catatonia manifest by riding the buses, po depakote or lithium for a possible chronic mania, 10mg daily of pimozide for a possible forme fruste of De Clerembault syndrome. If the patient slips into a more serious melancholic state, one might consider deep transcranial magnetic stimulation with ketamine augmentation. The sunovion rep told me that latuda is a good bet for these tricky situations regardless of the diagnosis especially as diagnosis is so passe and we've advanced to the point of thinking of functional neuronal connectivity, and targetting the negative and positive valence systems and modulating arousal/regulatory systems