Reply from Agar D Joseph
Week Six Discussion
St. Thomas University
NUR 620: Psychiatric Management I
Dr. Elvira Silva-De Vera
October 5, 2025
Mr. T is a 21-year-old male who presented to the emergency department exhibiting
a range of concerning symptoms, which include bizarre delusions, auditory
hallucinations, social withdrawal, and disorganized thought processes. He expresses a
belief that extraterrestrial beings are transmitting messages to him and implanting
thoughts within his mind. Additionally, Mr. T experiences auditory commands
instructing him to engage in self-harm; however, he currently denies any intention of
suicide.
Subjective and Objective Findings:
Subjectively, Mr. T demonstrates guarded behavior and expresses feelings of
paranoia. Objective observations indicate instances of thought blocking and vigilant
scanning of his environment for perceived threats. His mother reports a gradual decline
in his mental state over the past year, characterized by increasing social isolation, a
cessation of academic activities, and an intensifying focus on delusional content.
Furthermore, there is a documented family history of psychiatric illness; Mr. T’s father
exhibited similar symptoms and required extended psychiatric hospitalization.
Primary Diagnosis:
– Diagnosis: Schizophrenia, First Episode, Currently in Acute Phase
– **DSM-5-TR Code:** 295.90
– ICD-10 Code: F20.9
The symptoms exhibited by Mr. T—including delusions (belief in aliens),
hallucinations (auditory messages), and disorganized thought processes (thought
blocking)—align with the diagnostic criteria for schizophrenia as outlined in the DSM-5-
TR. This diagnosis necessitates the presence of at least two core symptoms persisting
for a minimum duration of six months, with at least one symptom being a delusion,
hallucination, or disorganized speech (American Psychiatric Association [APA], 2022).
The insidious onset of these symptoms, along with notable social and occupational
decline, provides further support for this diagnosis.
Differential Diagnoses:
1. Schizoaffective Disorder
– **DSM-5-TR Code:** 295.70
– **ICD-10 Code:** F25.0
– This disorder manifests mood episodes that occur concurrently with psychotic
symptoms. While Mr. T does not present with significant depressive or manic
symptoms, this diagnosis remains a consideration should mood symptoms develop.
2. Substance/Medication-Induced Psychotic Disorder
– **DSM-5-TR Code:** 292.89
– **ICD-10 Code:** F19.959
– Psychotic symptoms may arise due to substances or medications. It is advisable to
conduct a toxicology screen to rule out any stimulant-induced psychosis (e.g., resulting
from amphetamines or hallucinogens), as these substances can mimic primary
psychotic disorders (National Institute for Health and Care Excellence [NICE], 2023).
Pharmacological Treatment:
The recommended first-line pharmacological intervention is risperidone, initiated at
a dosage of 1–2 mg orally per day and titrated to therapeutic effect (maximum 6 mg/
day), in accordance with the treatment guidelines provided by the APA (2023) and NICE
(2023) for individuals experiencing first-episode schizophrenia. Risperidone is effective
in addressing positive symptoms such as delusions and hallucinations and presents a
more favorable side effect profile compared to first-generation antipsychotics. It is
essential to conduct baseline laboratory assessments—including a complete blood
count (CBC), lipid profile, fasting glucose, and liver function tests—to monitor for
potential metabolic side effects.
Non-Pharmacological Treatment:
Non-pharmacological interventions are critical in the management of early
psychosis. Cognitive-Behavioral Therapy for Psychosis (CBTp) can aid patients in
challenging delusional beliefs and enhancing cognitive insight. Family psychoeducation
may diminish relapse rates by fostering understanding and adherence to treatment
protocols. Coordinated Specialty Care (CSC), an evidence-based multidisciplinary
model, integrates psychotherapy, medication management, case management, and
support for employment and educational endeavors. This approach has demonstrated
improvements in functional outcomes for individuals experiencing first-episode
psychosis (Heilbronner et al., 2022).
Health Promotion Intervention:
Health promotion strategies should emphasize support for adherence to treatment
and relapse prevention. Educational initiatives regarding medication management, the
identification of early signs of relapse, and strategies for stress management should be
implemented. Given Mr. T’s family history and social withdrawal, a referral to a
community-based early intervention program for psychosis would be advantageous for
his long-term recovery and reintegration into educational and social contexts.
Additionally, promoting regular physical activity and balanced nutrition may contribute
to mitigating metabolic side effects associated with antipsychotic medications (APA,
2023).
Reply from Daniela Barbeito
Schizophrenia Spectrum Case Study
Clinical Summary
Mr. T is a 21-year-old male who has delusion beliefs related to aliens, thoughts
insertion and visual problems. On a subjective level, he narrates that the aliens are
communicating with him through sticks that are being put outside his home and sending images
to his head. According to the objective view, he is guarded, thought blocking, anxious, and
suspicious of the surroundings. His last year of gradual social withdrawal, poor academic
functioning and obsession with science fiction and protective equipment are the complaints of
his mother. His psychiatric family history is favorable, and his father had similar psychotic
symptoms and was admitted to a hospital, which suggests that there were genetic predispositions.
Diagnosis
The specified diagnosis is Schizophrenia, first episode, currently acute (DSM-5:
295.90; ICD-10: F20.9): the patient has delusions, thought insertion, disorganized thoughts, and
social/occupational decline more than six months. Schizophrenic disorder (DSM-5: 295.70;
ICD-10: F25.9) would be the first initial diagnosis since the mood disturbances would be
comorbid with psychosis, however, the description of the mood disturbances was not a central
feature of the case (Gangadin et al., 2024). The second alternative diagnosis is Delusional
Disorder, persecutory type (DSM-5: 297.1; ICD-10: F22) since the patient experiences ongoing
delusions of aliens, but the diagnoses is not common since the delusions are disorganized and the
patient himself is performing poorly (Haywood et al., 2024). The primary diagnosis of
Schizophrenia is the best because of the chronicity, the negative symptoms and family history.
Pharmacological Treatment
The American Psychiatric Association (APA) guidelines would make the first-line drug
of pharmacological treatment an unusual antipsychotic such as risperidone or aripiprazole. These
have positive symptoms (delusions, hallucinations) and very few extrapyramidal side effects as
compared to traditional antipsychotics. Risperidone is particularly useful and well tolerated with
first episode psychosis. There would be the need to closely monitor side effects such as
metabolic syndrome, sedation or prolactin increase. In case of resistance to treatment at that
point clozapine must also be considered but only after two unsuccessful attempts that have been
made with other antipsychotics.
Non-Pharmacological Treatment
The cognitive behavioral therapy of psychosis (CBTp) can be viewed as the non-
pharmacological intervention since they might enable Mr. T to re-process the delusional beliefs
and enhance the efficiency of coping strategies. Psychoeducation must be provided to both the
mother and the patient to facilitate insight, adherence to medication and the early detection of
symptoms of relapse (Ma, 2022). Social skills training and occupational therapy can help in
recovery and restore to normal everyday activity functions. Family therapy may also contribute
to the reduction of stress and expressed emotion consequently reducing the chance of relapse.
The combination of the solutions with medication is founded on the suggestion of the guidelines
on the complete treatment of schizophrenia.
Health Promotion Intervention
An adequate health promotion intervention would consist of the relapse prevention
program establishment through the medication adherence and frequent psychiatric follow-up and
lifestyle change. The reduction of the stress and the further improvement of the overall well-
being may be obtained in terms of sleep hygiene, healthy diet, and exercise education. Screening
and the recommendation of the avoidance of drugs is required because the use of drugs like
cannabis can aggravate psychosis (Gangadin et al., 2024). Peer support groups can help to
overcome the effects of isolation by promoting social interaction and therefore recovery. These
drugs are administered to manage mental and physical diseases, which will be beneficial in the
long term health and quality of life of Mr. T.
