Problem:
The patient is a married 38-year-old man working as a computer analyst for 15 years. His psychiatrist has moved away, and he needs a prescriber. His chief complaint is that "the government is out to get me and there is a grand conspiracy against me." Uneventful childhood. Became "suspicious" with some strange thoughts and sexual ideas in teens; diagnosed as OCD. He retained insight that they were excessive and not true. He would look at people in the face and develop disturbing sexual thoughts, so began to avoid eye contact. Given SSRIs with equivocal improvement. Some affective instability; variably diagnosed as bipolar disorder or schizoaffective disorder. Main treatment was psychotherapy between ages 19 and 27 which the patient believes helped him greatly "hold things together." After college, he got a job as a computer analyst for the government. He quit precipitously a few months ago after he began to think that the government was against him and they would "do him in" (that he would be choked to death). He is currently preoccupied by police cars, thinking they are after him. He now regrets resigning from his job but has no doubt that the government is actually after him. He admits no one else, including his wife, believes this. Affect somewhat flat but not overtly depressed. No other delusions or hallucinations. Family Hx: Sister and paternal aunt dx with schizophrenia. Current medication:
- Topiramate (Topamax) 300 mg/day
- Buproprion SR (Wellbutrin SR) 300 mg/day
- Buspirone (Buspar) 60 mg/day
- Paroxetine (Paxil) 60 mg/day
- Aripiprazole (Abilify) 40 mg/day
- Risperidone (Risperdal) 8 mg/day
Give a rationale for each of the medications (taking into consideration the dosage of each) related to this particular case. Need Assignment Help?
What do you think is his diagnosis? Explain your choice, and why/how you would rule out each of the other diagnoses.
- Paranoid schizophrenia
- Schizoaffective disorder
- Delusional disorder
- Simple schizophrenia
- Schizophreniform disorder
- Schizotypal personality disorder
- OCD vs Obsessive compulsive personality disorder (address both)
- Schizoid personality disorder