A 23-Year-Old Man with Schizophrenia Is Hospitalized in a Psychiatric

A 23-year-old man with schizophrenia is hospitalized in a psychiatric facility after barricading himself in his apartment for "self-defense."  The patient hears voices warning about "secret government agents" who are hunting him.  He is certain that a neighbor has been spying on him and listening through the wall on behalf of the government.  The patient's sister reports that he had his first psychotic episode at age 19 and responded well to olanzapine.  At age 21, he stopped taking olanzapine due to weight gain and was hospitalized with a psychotic relapse; he was prescribed risperidone while hospitalized.  The patient has been hospitalized 3 more times in the past 2 years.  Although he improves rapidly when hospitalized and taking risperidone and is then able to live independently, he typically relapses several months after discharge.  On mental status examination, the patient makes poor eye contact and has a flat affect.  He says, "I don't have a mental illness.  Can't you see the conspiracy is real?"  Which of the following is the most appropriate management for this patient?

A) Augment risperidone with sertraline
B) Augment risperidone with social skills training and family therapy
C) Discontinue risperidone and prescribe aripiprazole
D) Discontinue risperidone and prescribe clozapine
E) Increase the dosage of risperidone
F) Prescribe long-acting injectable risperidone

Correct Answer:

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