A 17-Year-Old With Hallucinations About Martians and Paranoia

Raheel I. Shaikh; Neal T. Patel; Alexander Martinek; Imran Shaikh, MD


September 28, 2021

Schizophrenia is a lifelong, serious, and persistent disorder that requires medication, psychotherapy, and patient and family education. The treatment of schizophrenia includes the use of antipsychotics and mental health interventions, such as cognitive-behavioral therapy.[1] Other approaches include vocational training, family therapy and education, day treatment programs, and group homes.

Antipsychotics are subdivided into typical and atypical agents. Atypical antipsychotics are preferred because they pose a lower risk for adverse effects, such as tardive dyskinesia.[7]

Typical antipsychotics, which were the first generation of antipsychotic medications, are dopamine antagonists that block the D2 receptor to decrease the effect of dopamine in the brain. Atypical antipsychotics, which are second-generation antipsychotic medications, also block 5-HT receptors in the serotonin pathway and thereby decrease extrapyramidal adverse effects, such as tardive dyskinesia. Cognitive-behavioral therapy may help patients come to terms with their illness, manage their hallucinations and delusions, and be better able to function in society.

In rare cases of treatment-resistant schizophrenia, electroconvulsive therapy is used to induce a very mild seizure in the brain with a low-voltage current.[7] The mechanism by which electroconvulsive therapy helps treat schizophrenia is unknown.

For this patient, risperidone, an atypical antipsychotic, was prescribed, and he was referred to a therapist for cognitive-behavioral therapy. He was also educated about smoking cessation because tobacco increases the metabolism of antipsychotics, which can negatively alter treatment outcomes. Options to incorporate a long-acting intramuscular antipsychotic injection into his treatment were also discussed, in case he failed to adhere to his medication regimen. Supportive work was done with his family, using a psychoeducational approach.


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