Paul began experiencing auditory hallucinations and delusions

Paul, who is now 36, began experiencing auditory hallucinations and delusions, displaying bizarre behaviors during his first year in college. After he was found hiding naked in the bushes near his dormitory because he believed the CIA was spying on him, Paul was hospitalized at age 19 and diagnosed with schizophrenia. Since that time, Paul has alienated himself from family and friends, spending much of his time locked in his tiny apartment where he watches television and smokes cigarettes much of the day. Unable to maintain steady employment, Paul currently receives Social Security Disability benefits to support himself. In the early course of his illness, Paul’s psychiatrist had prescribed him several trials of various typical antipsychotics including chlorpromazine, haloperidol, and loxapine; however, these drugs were only partially effective in reducing Paul’s hallucinations and delusions. More recently, Paul has been prescribed several different atypical antipsychotics including clozapine, aripiprazole, and lurasidone, but the metabolic side effects of these drugs, which include weight gain and hyperglycemia, have made Paul’s adherence sporadic at best. As a result, Paul has been hospitalized 12 times in the last 6 years for acute psychotic episodes and is on the verge of being evicted from his apartment.

What actions do you think would help improve Paul’s adherence: Medication monitoring, education about the importance of adherence, adjunctive treatments to reduce adverse events related to his medications, or possibly a multi-factorial approach utilizing two or more methods?

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