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A 21-Year-Old Man with a History of Schizophrenia Is Brought

question 263

Multiple Choice

A 21-year-old man with a history of schizophrenia is brought to the emergency department by his parents for agitation. Over the last month, the patient has exhibited increasingly odd behavior at home, such as accusing the FBI of sending him threatening messages through the radio. Earlier today, he threatened to kill himself and barricaded his bedroom door so that FBI agents would not find him. The patient has been taking olanzapine daily for the past 3 months under the supervision of his parents. Despite treatment, he has been unable to return to school or work and has persistent delusions of reference as well as recurrent episodes of paranoia, self-isolation, and poor hygiene. The patient has had multiple hospitalizations for similar behavior. He was initially treated with haloperidol, which resulted in muscle spasms and an inability to sit still; the patient was then switched to risperidone with minimal improvement of psychotic symptoms. Physical examination and laboratory evaluation are unremarkable. On mental status examination, he appears restless and makes minimal eye contact. Olanzapine is stopped and a new pharmacotherapy is planned. Which of the following is the most appropriate treatment for this patient?

Definitions:

Antigen-presenting Cells

Specialized cells that process and present antigens to T-cells, initiating an immune response.

Cold Viruses

Viruses responsible for the common cold, primarily rhinoviruses, which infect the respiratory tract and trigger symptoms like coughing and sneezing.

Thymus Gland

An endocrine gland that functions as part of the lymphatic system; processes T cells; important in cell-mediated immunity.

T Cytotoxic Cells

A type of T cell (a form of white blood cell) that kills cancer cells, cells that are infected (particularly with viruses), or cells that are damaged in other ways.