A 19-Year-Old Man Is Brought to the Emergency Department by His

question 647

Multiple Choice

A 19-year-old man is brought to the emergency department by his mother.  She says that he has been acting strangely for the past 2 months, spending significantly less time with his friends and more time on the computer.  Over the past few nights the mother has observed the patient shouting at the computer screen.  She became alarmed when he suddenly disconnected all electronic devices in the house and warned his family that encrypted messages were being sent over the internet to control his brain.  The patient's grades at the local community college have recently declined, and he stopped attending classes after he became convinced that other students were laughing at him behind his back.  He has no medical history.  Psychiatric history is significant for mild anxiety in high school that was never treated.  The patient does not use tobacco or alcohol but smokes marijuana daily.  He also has used cocaine on several occasions.  There is a family history of schizophrenia in a maternal uncle.  Vital signs are within normal limits and physical examination shows no abnormalities.  The patient is cooperative, guarded, and anxious during the interview.  Blood work and a CT scan of his brain are normal.  Urine toxicology is positive for tetrahydrocannabinol.  The mother asks if her son is going to be okay.  After obtaining consent from the patient to speak with his mother, which of the following is the most appropriate response to her at this time?

• A)His symptoms are likely related to drug use and should resolve as long as he abstains from drugs.
• B)The acute onset and presence of delusions are good prognostic factors, and he should respond well to treatment.
• C)This likely represents the onset of a major psychiatric illness given your son's age and the family history of schizophrenia.
• D)Your son is showing signs of psychotic illness, but the first step is to see to what extent his symptoms resolve when he stops using drugs.
• E)Your son likely has schizophreniform disorder; it is good you brought him in now as early medication treatment improves outcomes.

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Definitions:

Intramuscular Injections

A method of administering medication deep into the muscles, allowing for faster absorption than subcutaneous injections.

mg

Abbreviation for milligram, a unit of mass equal to one thousandth of a gram, often used in medication dosages.

IM

An abbreviation for "intramuscular," referring to a medication delivery method through injection directly into the muscle.

Needle Gauge

A measurement of the diameter of a needle, with higher gauge numbers indicating thinner needles.