PA is a 18 yo male college student brought in by police after being found running on the highway.
PA is a 18 yo male college student brought in by police after being found running on the highway. He is extremely paranoid and reports that the mafia is coming for him. When asked, he does admit to auditory hallucinations, mostly a commanding male voice telling him to hurt himself and his family. All pertinent labs and vitals are WNL, urine drug screen is negative. He is admitted to acute inpatient psychiatric unit for his first psychotic episode. He still lives with his parents and his father reports that over the past several months he has secluded himself to his room and can hear him talking “with someone” every once in a while. His father denies any previous medical or psychiatric history for PA and he is not currently taking any medications. He does report the following family history: DM2, dyslipidemia (father, paternal grandfather), schizophrenia (maternal aunt).
What treatment do you recommend for PA’s first psychotic episode? Be specific in your answer and support your choice with neurobiological rationale. Please be very specific in your answer and rationale. Do not go into detail about the disorder at the expense of detail regarding the current treatment of the patient. Choose your treatments as you would if the patient were in front of you. Do not give vague or generalized treatment plans; choose a treatment and explain why you chose it instead of any other options. Include any and all considerations that accompany your choice of treatment plan. For instance, do any diagnostics need to be done prior to initiating a drug?
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