Case Study #3
Auditory and Visual Hallucinations in a 22-Year-Old
The Issue: Refractory hallucinations complicated by drug use
Patient Intake
The patient is a 22-year-old single man whose chief complaint is that "a demon is following [him]"
He has had auditory and visual hallucinations revolving around this demon for more than 6 months;
in some cases, the demon has commanded him to kill himself
He is currently experiencing intermittent hallucinations, anxiety, poor concentration, and insomnia
He has no suicidal or homicidal ideation, but he fears that the demon will compel him to commit an
act
He denies delusions, grandiosity, a decreased need for sleep, hyper-religious thoughts, and
increased goal-directed activity
There is no evidence of negative symptoms, disorganized thoughts, or pressured speech
There is no family history of psychiatric illness
The patient is voluntarily admitted to an inpatient psychiatric unit in the context of command auditory
and visual hallucinations
He is diagnosed with psychotic disorder NOS and marijuana dependence, with consideration for a
diagnosis of substance-induced psychosis
Patient History
The patient was diagnosed with anxiety and depression in high school; he has had psychotherapy
and previous treatment with paroxetine and fluoxetine
He has had no previous hospitalizations
He admits to using marijuana intermittently and more frequently in the last 6 months, believing that it
would help his hallucinations
He is not currently taking any medications
Questions: (continued on Page 2)
1. Considering the patient’s symptoms, what type of antipsychotics would be most appropriate?
(Think dopamine). Please explain your choice.
2. Can substance induced psychosis be treated with antipsychotics?
3. Would a LAI (long acting injectable) be appropriate for this patient? Please explain why or why
not.
4. Let’s pretend Seroquel was prescribed for this patient. Explain how and why Seroquel can have
a different effect at different doses.
5. Antipsychotics are often prescribed “off label” (to treat symptoms for which they do not have FDA
approval). Choose any antipsychotic and research why it is used “off label.” Locate a peer-
reviewed article that offers evidence in support or against using that antipsychotic for this reason.
Example: Risperidone for OCD
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