“They are trying to poison me.”
History of Present Illness
LM is a 38-year-old male who is brought to the emergency department by a staff member of his group home. The patient complains that staff at his group home are trying to poison him. He states that he has stopped eating and taking his medications because of this. He states that he hears voices that tell him not to eat because the staff are “out to get me.” Group home staff report that the patient has not been eating his meals for 3 days, even with significant prompting.
Diagnosed with schizophrenia at age 22. Patient has been hospitalized for psychiatric symptoms four times in his life. Patient was started on clozapine 9 months ago and was doing well in his group home according to staff. Past medication trials of olanzapine, paliperidone, risperidone, and ziprasidone were unsuccessful.
Past Medical/Surgical History
Uncle from his mother’s side has schizophrenia
Mother has anxiety disorder
State Medicaid; medication coverage is not a problem
Clozapine 150 mg PO bid
Atorvastatin 20 mg PO at bedtime
Lisinopril 20 mg PO daily
Hydroxyzine pamoate 50 mg every 6 hours PRN anxiety
Overweight, disheveled male appearing stated age.
Mental Status Examination
Grooming and hygiene were poor. Patient was observed attending to internal stimuli. Speech was normal rate and quiet volume at times. No psychomotor abnormalities appreciated.
Patient describes his mood as “fine.” His affect was flat, constricted, non-labile, but congruent with stated mood.
Awake and alert, appears grossly oriented, but not formally tested.
Not formally tested. Average based upon vocabulary and general fund of knowledge.
Unable to maintain attention and concentration during the interview.
Not formally tested, appears intact based on ability to recall and discuss recent events.