Reference no: EM133307014

Question 1. In addition to the diagnosis suggested by the text authors, are there additional disorders that may apply or should be ruled-out?
Question 2. Do you agree with the medication suggestions made by the text authors?

Question 3. Any other medications that might be considered...and what is the rationale?

Question 4. Are the suggested medications, or any other considered medications, agonists or antagonists?

Question 5. If you were asked to follow-up on this case as the treating therapist, what would your treatment plan be? Include collaboration and consultation.

Case of Christopher in Chapter 8

Christopher is an 18-year-old college freshman who identifies as a gay man. Christopher has just returned from the summer break. He lives in a fraternity on campus that just held its welcome-back beer bash. When the party was over, his two roommates noticed that he was acting strange. At first, they just thought he was drunk and ignored his behavior, but around 3:00 a.m. he started to become paranoid and combative with others in the house. There were reports from observers that he was convinced that his frat brothers were "in a conspiracy with aliens to steal intelligence secrets from the university." It escalated to the point that he barricaded himself in his room and campus security was called. He was taken to a secure psychiatric facility. After examination, it was determined that he was not under the influence of drugs and actually had very little alcohol in his system. He was kept in the facility for 72 hours for further evaluation.

POSTCASE DISCUSSION AND DIAGNOSIS Christopher's father provided history to the social worker at the facility. As it turns out, Christopher's mother was diagnosed with schizoaffective disorder several years before Christopher's birth and was placed on medication after a stay in the hospital. His older brother was once diagnosed as schizotypal when he was a student in college; he now works as a video game engineer. His maternal grandmother also was diagnosed with a "psychiatric illness" and was hospitalized at various times in her life. There is no psychiatric illness on the father's side of the family. After an examination by the attending psychiatrist, the diagnosis was first-episode Schizophrenia (F20.9).

PSYCHOPHARMACOLOGICAL TREATMENT Christopher was rather agitated when he arrived at the facility and was given a Zyprexa injection. When he was calmer and had an opportunity to adjust to the unit, he was interviewed by several of the treatment staff. This included a social worker, a psychologist, and the attending psychiatrist. His paranoid ideations continued, and he refused to sit in the dayroom as he was convinced that the TV monitor was beaming messages to the very aliens trying to steal intelligence information. He told staff he could hear their voices even when the monitor was turned off. When staff attempted to work with him and get him to interact with others, he became aggressive and stayed in his room. He was placed on 3 mg daily of risperidone. Over a period of three days, he became less combative and the hallucinations diminished substantially. The dose was increased to 6 mg per day, and Christopher was monitored closely by the staff. His progress continued, and he was discharged two weeks later with a referral for outpatient treatment and medication management.