Behavioral Health

Schizophrenia: Ensuring an accurate Dx, optimizing treatment

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First rule out secondary psychosis with appropriate lab tests and imaging studies, as needed. Give an antipsychotic for at least 4 weeks to judge its effectiveness.




Steven R,* a 21-year-old man, visited the clinic accompanied by his mother. He did not speak much, and his mother provided his history. Over the previous 2 months, she had overheard him whispering in an agitated voice, even though no one else was nearby. And, lately, he refused to answer or make calls on his cell phone, claiming that if he did it would activate a deadly chip that had been implanted in his brain by evil aliens. He also stopped attending classes at the community college. He occasionally had a few beers with his friends, but he had never been known to abuse alcohol or use other recreational drugs.

How would you proceed with this patient?

* The patient’s name has been changed to protect his identity.


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