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Question - A 20-year-old patient is brought to the emergency room by mother. Mother states for the past 7 months, patient has been stating they have been hearing two people discuss about them even when others cannot hear those voices. Patient has been found talking to these voices on several occasions. States patient has been making up new words that do not seem to make sense and communication has been incomprehensible. States patient has refused to shower for at least a month or clean up their room. Mother denies any trauma or known substance use. Patient has type II diabetes and is currently on Metformin (Glucophage). Mother states decided to bring patient in because patient states the voices are telling them to end it all as they are not good enough.
A. What is the probable diagnosis? Please include a detailed paragraph why you came to this conclusion by discussing differential diagnoses and DSM5 criteria for the case.
B. What labs or diagnostic tests may be needed?
C. What specific medication would you be initiating and why? (Use clinical guidelines for your rationale)
D. What is the mechanism of action of this medication?
E. What are the clinical considerations with initiating this medication? Include patient education and safety concerns.
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