From the Guidelines
The most appropriate response by a physician would be to acknowledge the patient's concerns without directly challenging or reinforcing her paranoid beliefs, saying something like: "I can see this has been very upsetting for you. I'd like to learn more about how it's been affecting you." This approach is supported by the American Psychiatric Association's practice guideline for the treatment of patients with schizophrenia, which emphasizes the importance of a person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments for schizophrenia 1. The physician should then assess if the patient's current risperidone regimen needs adjustment, as the presence of paranoid thoughts suggests her schizophrenia symptoms may not be adequately controlled. Some key points to consider when evaluating and managing the patient's schizophrenia symptoms include:
- Checking medication adherence and considering a dosage increase or potentially adding another antipsychotic medication, such as olanzapine or quetiapine, which have been shown to be effective in managing schizophrenia symptoms 1
- Performing a thorough evaluation of the patient's current mental status, including assessing for any safety concerns or risk of harm to self or others
- Using verbal restraint strategies, such as establishing verbal contact, being concise, and identifying the patient's goals and expectations, to help de-escalate the situation and build trust with the patient 1
- Considering the use of benzodiazepines or antipsychotics to manage acute agitation, if necessary, while also being mindful of the potential risks and side effects associated with these medications 1. The physician should also schedule a prompt follow-up appointment to monitor the patient's response to any medication adjustments and continue addressing her concerns.
From the Research
Patient Concerns and Physician Response
The patient presents with paranoid thoughts and asks if the physician believes her concerns about being poisoned by her neighbors. The most appropriate response by the physician is to acknowledge the patient's concerns without dismissing or confirming them.
- The physician should respond in a empathetic and non-judgmental manner, as seen in option A) "I can see this has been very upsetting for you. I'd like to learn more about how it's been affecting you" 2.
- This response acknowledges the patient's feelings and shows interest in understanding her concerns, which is essential in building a therapeutic relationship.
- Option B) "I think that these thoughts are symptoms of your mental health condition. Let's talk about what we can do to help" may come across as dismissive of the patient's concerns and may not be the most appropriate initial response.
- Options C) "No, I don't think that the neighbors are poisoning you, but I think we can work together to find a solution" and D) "What makes you think that the neighbors are poisoning you? Do you have any evidence this is happening?" may be seen as confrontational or challenging, and may not help to establish trust with the patient.
- Option E) "Yes, of course I believe you. Let's see what we can do to get the poisoning to stop" is not a suitable response as it may reinforce the patient's delusional thoughts.
Schizophrenia and Risperidone Treatment
The patient has a history of schizophrenia and is taking risperidone, which has been shown to be effective in treating symptoms of schizophrenia 3, 4, 5.
- Risperidone has been found to improve symptoms of paranoia and agitation in patients with schizophrenia 3, 4.
- The patient's concerns about being poisoned by her neighbors may be a symptom of her underlying schizophrenia, and the physician should consider this when responding to her concerns.
- The physician should also be aware of the potential side effects of risperidone, such as extrapyramidal disorders and weight gain 4, and monitor the patient's treatment response and adjust the medication as needed.