The most interesting client this writer has encountered was a 26-year-old male diagnosed with schizophrenia. This writer found him to be interesting because he enjoyed the company of his auditory hallucinations and did not want any interventions that would completely eliminate the hallucinations. Per the client’s records, he was diagnosed with schizophrenia at 21 years of age during his junior year of college. He was hospitalized for stabilization when the diagnosis was made. Per the documentation, his mother reported that he was paranoid, delusional, not sleeping or showering and “talking and laughing to himself”. His paranoia was so severe that he unenrolled from school and stopped eating for 4 days because he thought the school hired the FBI to watch him and the school’s food was poisoned. The behaviours persisted for approx. 2 months after he returned home before he was hospitalized. In addition to these symptoms, the mother reported sleep disturbances. Today, he presents inappropriately dressed and dishevelled. During the interview, he frequently responds to internal stimuli. He responds appropriately to questions and has poor eye contact. According to the American Psychiatric Association, a diagnosis of schizophrenia can be made if two symptoms of psychosis including delusions and hallucinations are present most of the time for a minimum of 1 month (2013). His symptoms negatively impacted his level of functioning with self-care and education and residual symptoms including auditory hallucinations have been present longer than 6 months. Due to the symptoms listed this writer believes the appropriate treatment at this time is medication management, specifically an atypical antipsychotic. Prior to prescribing any medication baseline vital signs and laboratory data, height, weight, and waist circumference should be obtained because treatment with antipsychotic medications can cause metabolic syndrome. Labs should include a baseline EKG, CBC, LFT, thyroid panel, CMP, prolactin, folate, vitamin D, and urinalysis. At this time, the client is not interested in psychotherapy.   References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

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