Patient History: A 22-year-old man presents to the emergency room with a chief complaint of “they are making me look toward heaven.” The patient admits to a past diagnosis of schizophrenia, “but God cured me of it.” He was, in fact, just discharged from the hospital the previous week on risperidone 4 mg at bedtime. His dose was subsequently increased to 6 mg by his outpatient psychiatrist 2 days prior to this visit. The patient believes that angels are forcing him to look up at heaven as since this morning he has been unable to look “downward to the devil in hell.” Examination: His mental status examination is significant, though he is cooperative and appropriately dressed. His speech is not spontaneous. His mood is “worried,” but his affect is flat.
His thoughts are logical. He denies suicidal or homicidal ideation but he has delusions. His insight is poor. His physical examination is…
