A 32-Year-Old Man Comes to the Office for a Follow-Up

A 32-year-old man comes to the office for a follow-up appointment accompanied by his sister.  The patient has a long history of schizophrenia and was hospitalized multiple times in his early 20s.  He has been on fluphenazine decanoate, depot form, for several years.  He has no current delusions or hallucinations.  The patient describes his mood as "okay" and he is sleeping and eating well.  During the interview, the physician notices that he answers questions appropriately but offers monosyllabic responses.  He makes no small talk and does not speak unless asked a question.  His affect is flat, and he speaks in a monotone voice.  The patient's sister confirms that he is adherent with his medications and has not been "acting or thinking strangely" for some time.  He says that he would like to work but has made no effort to find a job in more than a decade.  Physical examination is unremarkable, and there are no signs of extrapyramidal side effects.  At the end of the appointment, the sister asks, "Is there anything you can recommend that will make him get out of the house or look for some kind of work?  All he does is sit at home and watch TV.  It's like he doesn't care."  Which of the following is the most appropriate response?

A) Adding valproate might improve his mood and motivation.
B) Giving him feedback about his behavior and strong encouragement to be more active should help.
C) Increasing the antipsychotic dosage might improve his apathy and social withdrawal.
D) Social skills training may be helpful in targeting these symptoms.
E) Switching to a second-generation antipsychotic should significantly improve his apathy and withdrawal.