11-30-2010, 08:36 AM
A40-year-old single male with chronic schizophrenia
is seen for a routine primary care clinic
appointment for diabetes management. He is currently
taking glyburide 5 mg bid and aripiprazole
(Abilify) 20 mg daily. He claims to be compliant
with his medications but appears poorly groomed
with noticeable body odor. He is reluctant to talk,
being somewhat guarded, but he eventually confides
that he has been programmed by the government
to kill his landlord, who he is convinced is
working for Al Qaeda. His orders have been transmitted
through his apartment walls to a receiver in
his brain. He has been informed that if he does not
comply, he will be sent to hell, so he has recently
purchased several knives and plans to carry out
“my mission” as soon as possible. When the subject
of voluntary admission is brought up, he adamantly
refuses.
What is the most appropriate next step in his
management?
(A) admit the patient involuntarily
(B) call the landlord and warn him
© continue current medications with close
follow-up
(D) discuss the potential legal issues with
the patient
(E) switch the patient to another atypical
antipsychotic
is seen for a routine primary care clinic
appointment for diabetes management. He is currently
taking glyburide 5 mg bid and aripiprazole
(Abilify) 20 mg daily. He claims to be compliant
with his medications but appears poorly groomed
with noticeable body odor. He is reluctant to talk,
being somewhat guarded, but he eventually confides
that he has been programmed by the government
to kill his landlord, who he is convinced is
working for Al Qaeda. His orders have been transmitted
through his apartment walls to a receiver in
his brain. He has been informed that if he does not
comply, he will be sent to hell, so he has recently
purchased several knives and plans to carry out
“my mission” as soon as possible. When the subject
of voluntary admission is brought up, he adamantly
refuses.
What is the most appropriate next step in his
management?
(A) admit the patient involuntarily
(B) call the landlord and warn him
© continue current medications with close
follow-up
(D) discuss the potential legal issues with
the patient
(E) switch the patient to another atypical
antipsychotic