Posted: December 9th, 2022

An 18-year-old is brought to the ER

An 18-year-old is brought to the ER by his mother after he began talking about “aliens” who are trying to steal his soul. He reports that aliens leave messages for him by arranging sticks outside his home and sometimes send thoughts into his mind. On review, he is guarded and often stops talking while in the middle of expressing his thoughts. He appears anxious and frequently scans the room for aliens, which he thinks may have followed him to the hospital. He denies any plans to harm himself but admits that the aliens sometimes want him to throw himself in front of a car, “as this will change the systems that belong under us” The patient’s mother reports that he began experiencing these ideas a few months ago, but they have become more severe in the last few weeks. She reports that during the past year, he has become isolated from his peers, frequently talks to himself, and has stopped going to school. He has also spent most of his time reading science fiction books and creating devices that will prevent aliens from hurting him. She expresses concern because the patient’s father, who abandoned the patient when he was a child, displayed similar symptoms many years ago and has spent the majority of his life in psychiatric hospitals. She reports that she is concerned because the patient’s father, who left while the patient was a child exhibited similar symptoms many years ago and has spent most of his life in psychiatric hospitals.

Question(s): What is the patient’s most likely diagnosis? What differential diagnosis should be considered? What labs will the PMHNP obtain to help rule out any organic causes for the patient’s presentation? What would be appropriate steps for the PMHNP to take in the acute management of this patient?

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