Psych- schizoaffective disorder
harry206 - 05-17-09 01:50

A 57-year-old man with schizoaffective disorder, whose symptoms were in remission until 2 weeks ago,
is brought to the emergency department by his girlfriend. He will not talk with you but the girlfriend tells
you that he has a history of "overdoses", and she is afraid he has taken a lot of "his pills". He has been
complaining of voices telling him he "should be dead". He has not left the house in a month and has
spent several hours a day looking out the window for the "king and savior" to "come take him". His
medications include haloperidol, valproic acid, and a small dose of amitriptyline for chronic pain related
to nerve damage in his leg, which occurred in a motor vehicle accident 10 years ago. He has no other
medical problems. A chart review reveals that he has no allergies and was diagnosed with
schizoaffective disorder 30 years ago. His temperature is 37.0 C (98.6 F), blood pressure is 110/70
mm Hg, pulse is 70/min, and respirations are 26/min. He is a depressed appearing man with very poor
eye contact. He smells of alcohol. He does not acknowledge you, but will answer some questions for his
girlfriend. He does admit to feeling that "life is not worth living" and feeling "more religious than usual".
He seems slightly drowsy and knows the date. His physical examination is normal. The most
appropriate next step in management is to order