A patient with paranoid schizophrenia and anosognosia has had several hospitalizations.He responds quickly to antipsychotic medication but stops taking the medication soon after discharge.Discharge planning will include follow-up at the mental health clinic,placement in a group home,and daily attendance at a psychosocial day program.Which medication strategy will most likely be used as he transitions from hospital to community?

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Quizplus · Accepted Answer

Persons with paranoia and anosognosia are at high risk for treatment nonadherence,so the strategy needs first and foremost to address that risk.Of the options here,involving the patient in the decision is best because it will build trust and help establish a therapeutic alliance with care providers,an essential foundation to adherence and an even greater concern given his paranoia.Intramuscular depot medications can be helpful for promoting adherence if other alternatives have been unsuccessful,but IM medications are painful and less likely to be accepted by a paranoid person.All of the other strategies also apply but are secondary to trust and bonding with his providers.

A Patient with Paranoid Schizophrenia and Anosognosia Has Had Several